title: Mini-Invasive floating metatarsal osteotomy for resistant or recurrent neuropathic plantar metatarsal head ulcers.
abstract: BACKGROUND
  Patients with peripheral neuropathy and pressure under a relatively plantar deviated metatarsal head frequently develop plantar foot ulcers. When conservative management with orthotics and shoes does not cure the ulcer, surgical metatarsal osteotomy may be indicated to relieve the pressure and enable the ulcer to heal. The purpose of this study is to evaluate the use of a mini-invasive floating metatarsal osteotomy in treating recalcitrant ulcers or recurrent ulcers plantar to the metatarsal heads in patients with diabetes mellitus (DM) related neuropathy.
  
  
  METHODS
  Computerized medical files of patients with diabetic neuropathy treated with an osteotomy during 2013 and 2014 were retrospectively reviewed. There were 20 osteotomies performed on 17 patients (mean age 58 years). The patients had a diagnosis of DM for a mean of 17 years. All ulcers were University of Texas grade 1A; mean ulcer age was 19 months.
  
  
  RESULTS
  After 17/20 operations, the ulcer completely resolved after 6 weeks and did not recur after a mean follow-up of 11.5 months. One patient developed an early post-operative infection with osteomyelitis at the osteotomy site (proximal shaft of the fifth metatarsal) that needed debridement and IV antibiotics. In the other 19 cases, the surgical wound healed within 1 week. Asymptomatic radiological non-union developed in six cases (30 %).
  
  
  CONCLUSIONS
  Mini-invasive floating metatarsal osteotomy can cure resistant and recurrent University of Texas grade 1A ulcerations plantar to the metatarsal heads in neuropathic patients.
authors.affiliation: Department of Orthopaedic Surgery, Assaf HaRofeh Medical Center, Zerrifin, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.|Maccabi Health Services, POB 1424, Reut, 71799, Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Tamir
authors.affiliation: Department of Orthopaedic Surgery, Assaf HaRofeh Medical Center, Zerrifin, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. asff@inter.net.il.|Maccabi Health Services, POB 1424, Reut, 71799, Israel. asff@inter.net.il.
authors.forename: Aharon S
authors.initials: AS
authors.lastname: Finestone
authors.affiliation: Department of Orthopaedic Surgery, Assaf HaRofeh Medical Center, Zerrifin, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Erez
authors.initials: E
authors.lastname: Avisar
authors.affiliation: Department of Orthopaedic Surgery, Assaf HaRofeh Medical Center, Zerrifin, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Agar
mesh_terms: D000328:Adult; D000368:Aged; D003920:Diabetes Mellitus / Q000000981:diagnostic imaging / Q000601:surgery*; D017719:Diabetic Foot / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010027:Osteotomy / Q000379:methods*; D010523:Peripheral Nervous System Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies
keywords: Amputation; Diabetic foot; Metatarsal osteotomy; Prophylactic surgery