García-Madrid Marta, García-Álvarez Yolanda, Álvaro-Afonso Francisco Javier, García-Morales Esther, Tardáguila-García Aroa, Lázaro-Martínez José Luis
Diabetic Foot Unit, Clínica Universitaria de Podología, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
J Clin Med. 2021 May 24;10(11):2260. doi: 10.3390/jcm10112260.
To evaluate the metatarsal head that was associated with the highest plantar pressure after metatarsal head resection (MHR) and the relations with reulceration at one year, a prospective was conducted with a total of sixty-five patients with diabetes who suffered from the first MHR and with an inactive ulcer at the moment of inclusion. Peak plantar pressure and pressure time integral were recorded at five specific locations in the forefoot: first, second, third, fourth, and fifth metatarsal heads. The highest value of the four remaining metatarsals was selected. After resection of the first metatarsal head, there is a displacement of the pressure beneath the second metatarsal head ( < 0.001). Following the resection of the minor metatarsal bones, there was a medial displacement of the plantar pressure. In this way, plantar pressure was displaced under the first metatarsal head following resection of the second or third head ( = 0.001) and under the central heads after resection of the fourth or fifth metatarsal head ( < 0.009 and < 0.001 respectively). During the one-year follow-up, patients who underwent a metatarsal head resection in the first and second metatarsal heads suffered transfer lesion in the location with the highest pressure. Patients who underwent a minor metatarsal head resection (second-fifth metatarsal heads) showed a medial transference of pressure. Additionally, following the resection of the first metatarsal head there was a transference of pressure beneath the second metatarsal head. Increase of pressure was found to be a predictor of reulceration in cases of resection of the first and second metatarsal heads.
为评估跖骨头切除术后（MHR）与最高足底压力相关的跖骨头以及与一年后再溃疡的关系，对65例首次接受MHR且纳入时溃疡不活动的糖尿病患者进行了一项前瞻性研究。在前足的五个特定位置记录峰值足底压力和压力时间积分：第一、第二、第三、第四和第五跖骨头。选取其余四个跖骨中的最高值。切除第一跖骨头后，第二跖骨头下方的压力发生移位（<0.001）。切除较小的跖骨后，足底压力向内侧移位。这样，切除第二或第三跖骨头后，足底压力在第一跖骨头下方移位（=0.001），切除第四或第五跖骨头后，足底压力在中央跖骨头下方移位（分别为<0.009和<0.001）。在一年的随访中，第一和第二跖骨头接受跖骨头切除的患者在压力最高的部位出现转移病变。接受较小跖骨头切除（第二至第五跖骨头）的患者显示压力向内侧转移。此外，切除第一跖骨头后，第二跖骨头下方出现压力转移。发现压力增加是第一和第二跖骨头切除病例中再溃疡的一个预测指标。
