Chronic Neuropathic Forefoot Plantar Ulcers; Metatarsal Head Resection Versus Conservative Care

Background: The annual incidence of diabetic foot ulcers is between 2% and 4% in developed nations, and it is probablyeven higher in developing nations. Peripheral sensory neuropathy, foot abnormalities, and peripheral arterial disease arethe main causes of their development. Offloading is important in the management of pressure ulcers, and all efforts should be made to enhance patient understanding of the need for offloading.Objective: To evaluate the clinical outcomes of combined surgical and mechanical offloading compared to mechanicaloffloading alone in the management of chronic unhealed diabetic forefoot plantar ulcers.Methodology: This randomized prospective comparative study was conducted on thirty diabetic patients with chronicunhealed forefoot plantar pressure ulcers. The thirty patients were divided into two equal groups, group (A) and group(B). Group (A) included 15 patients for whom surgical offloading was performed in addition to mechanical offloading(e.g., air walkers or therapeutic shoes). Group (B) also included 15 patients for whom non-surgical offloading alone wasprescribed (e.g., air walkers or therapeutic shoes). For 12 weeks, all participants were monitored to ensure full ulcerhealing.Results: The successful rate of complete ulcer healing was 100% and 73.3% for surgical and non-surgical methods,respectively. There was a greater reduction in plantar peak pressure with surgery compared to non-surgical approaches.Conclusion: Surgical offloading techniques were found to be superior to non-surgical offloading methods as regardscomplete ulcer healing, which should gain popularity in the coming decades.