Department of Orthopaedic Surgery, Shamir Medical Center, Zerrifin, Israel.
Maccabi Health Services, Tel Aviv, Israel.
Foot Ankle Int. 2021 May;42(5):536-543. doi: 10.1177/1071100720976099. Epub 2020 Dec 17.
Distal metatarsal osteotomy has been used to alleviate plantar pressure caused by anatomic deformities. This study's purpose was to examine the effect of minimally invasive floating metatarsal osteotomy on plantar pressure in patients with diabetic metatarsal head ulcers.
We performed a retrospective case series of prospectively collected data on 32 patients with diabetes complicated by plantar metatarsal head ulcers without ischemia. Peak plantar pressure and pressure time integrals were examined using the Tekscan MatScan prior to surgery and 6 months following minimally invasive floating metatarsal osteotomy. Patients were followed for complications for at least 1 year.
Peak plantar pressure at the level of the osteotomized metatarsal head decreased from 338.1 to 225.4 kPa ( < .0001). The pressure time integral decreased from 82.4 to 65.0 kPa·s ( < .0001). All ulcers healed within a mean of 3.7 ± 4.2 weeks. There was 1 recurrence (under a hypertrophic callus of the osteotomy) during a median follow-up of 18.3 months (range, 12.2-27). Following surgery, adjacent sites showed increased plantar pressure and 4 patients developed transfer lesions (under an adjacent metatarsal head); all were managed successfully. There was 1 serious adverse event related to surgery (operative site infection) that resolved with antibiotics.
This study showed that the minimally invasive floating metatarsal osteotomy successfully reduced local plantar pressure and that the method was safe and effective, both in treatment and prevention of recurrence.
Level III, retrospective case series of prospectively collected data.
远端跖骨截骨术已被用于缓解解剖畸形引起的足底压力。本研究旨在探讨微创浮式跖骨截骨术对糖尿病跖骨头溃疡患者足底压力的影响。
我们对 32 例糖尿病合并无缺血性跖骨头溃疡的患者进行了前瞻性数据回顾性病例系列研究。在微创浮式跖骨截骨术前和术后 6 个月，使用 Tekscan MatScan 检查足底跖骨头处的峰值足底压力和压力时间积分。患者至少随访 1 年以观察并发症。
截骨跖骨头处的峰值足底压力从 338.1kPa 降至 225.4kPa（<0.0001）。压力时间积分从 82.4kPa·s 降至 65.0kPa·s（<0.0001）。所有溃疡在平均 3.7±4.2 周内愈合。平均随访 18.3 个月（12.2-27）时，1 例（截骨处肥厚性骨痂下）复发。在随访过程中，相邻部位的足底压力增加，4 例发生转移病变（相邻跖骨头下）；所有病例均成功处理。有 1 例与手术相关的严重不良事件（手术部位感染），经抗生素治疗后痊愈。
本研究表明，微创浮式跖骨截骨术可成功降低局部足底压力，且该方法在治疗和预防复发方面安全有效。
三级，前瞻性数据回顾性病例系列研究。
