title: [Conservative surgical treatment for diabetic foot ulcers under the metatarsal heads. A retrospective case-control study].
abstract: OBJECTIVE
  The plantar neuropathic ulcer is a classical and frequent complication of a pathology recognized as pandemic by the WHO: diabetes. Even if frequently encountered during medical practice, the neuropathic ulcer remains poorly understood in its pathophysiology. Its treatment is usually long and disappointing, resulting too often in an amputation. Paradoxically, medical literature is particularly scarce on the subject of surgical approaches to the plantar neuropathic ulcer. Beyond the cases of vascular lesions requiring above all a technique of revascularization, we have tested out an original approach enabling the surgical treatment of an overt neuropathic ulcer. Our purpose was to correct the architecture of the foot for a superior distribution of foot support points. We performed subtraction osteotomies ahead of the neuropathic ulcer in order to redress the deformed bone axis. Standing with full weight on the foot is prescribed from the following day of the intervention in almost all cases.
  
  
  METHODS
  We have evaluated the effectiveness of this innovative conservative surgical treatment on neuropathic ulcers of metatarsal heads by comparing it with the usual medical treatment. Two groups of patients have thus been analysed for this retrospective comparative study in order to determinate whether the use of this surgical technique benefits the patient. The studied criteria were healing time, recurrence rate, amputation rate and overall failure rate of the treatment, represented by the occurrence of the event "recurrence or amputation".
  
  
  RESULTS
  All the differences found were in favour of the surgical technique with, in particular, significant differences in healing time, amputation rate and occurrence rate of the event "recurrence or amputation". The difference in recurrence rate was also clearly in favour of the surgery group, but it was not significant.
  
  
  CONCLUSIONS
  The conservative surgical treatment by proximal osteotomy is therefore an innovative technique enabling a significant improvement in healing time and treatment after-effects of neuropathic ulcers in non-arteritis diabetic patients.
authors: Service de chirurgie plastique, reconstructrice et esthétique, hôpital Roger Salengro, rue Émile-Laine, 59037 Lille, France. Electronic address: bvanlerberghe@free.fr.
authors: B
authors: B
authors: Vanlerberghe
authors: Service de médecine, hôpital Dr Shaffner, 99, route de La Bassée, 62300 Lens, France.
authors: F
authors: F
authors: Devemy
authors: Département de biostatistiques, CHRU de Lille, 154, rue du Docteur-Yersin, 59037 Lille, France.
authors: A
authors: A
authors: Duhamel
authors: Service de chirurgie plastique, reconstructrice et esthétique, hôpital Roger Salengro, rue Émile-Laine, 59037 Lille, France.
authors: P
authors: P
authors: Guerreschi
authors: Service de chirurgie orthopédique et plastique septique, institut Calot, 1, rue du Docteur-Calot, 62600 Berck-sur-Mer, France.
authors: D
authors: D
authors: Torabi
mesh_terms: D016022:Case-Control Studies; D017719:Diabetic Foot / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008682:Metatarsal Bones; D010027:Osteotomy / Q000379:methods; D012189:Retrospective Studies
keywords: Chirurgie; Conservative treatment; Diabetes; Diabète; Mal perforant plantaire; Metatarsal; Métatarsien; Osteotomy; Ostéotomie; Plantar neuropathic ulcer; Surgery; Traitement conservateur