Definitive surgical treatment for diabetic forefoot ulcer

M. K. Rajendran


Background: Diabetic foot ulcers are common among 15% of the diabetic population, at one stage of life that may progress to minor or major amputation, because of not healing with all modalities of the treatment. Since recurrent rate is >90%. But the surgical treatment of the forefoot ulcer so-called surgery offloading will heal the ulcer within a short time and prevent minor of major amputation. The purpose of this study was to compare different outcome measures in the audit of the management of diabetic foot ulcers.

Methods: Totally 20 diabetic patients were included in the study. The study was conducted in the department of plastic surgery, Government Mohan Kumaramangalam Medical College Hospital, from 2016-2018. Followed 20 patients with a surgical procedure called surgical offloading is by removing pressure element in head and neck of metatarsal bone involved.

Results: Among the 20 patients wound healed, in about 12 patients within 4 to 5 week and its remaining 5 patients wound healed in 5 to 6 weeks are in other 2 patients it takes. More than 6 weeks to heal. We followed the patients for the past 1 year, out of 20 patients, 2 patients have developed an ulcer in another site, not the same site. In all other patients wound healed completely without any recurrence.

Conclusions: In our study reducing the foot pressure by doing an excision of head and neck metatarsal surgically will completely remove the foot pressure over the ulcer site that helps to heal the ulcer without recurrence.


Forefoot ulcer, Head and neck of metatarsal bone excision, Recurrence, Surgical management

Full Text:



Boulton AJM, Vileikyte L, RagnarsonTenvall G, Apelqvist J. The global burden of diabetic foot disease. Lancet. 2005;366:1719-24.

Cavanagh PR, Lipsky BA, Bradbury A, Botek G. Treatment for diabetic foot ulcers. Lancet. 2005;389:1725-35.

Singh N, Armstrong DSG, Lipsky BA: Preventing foot ulcers in patients with diabetes. JAMA. 2008;293:217-28.

American Diabetes Association. Peripheral arterial disease in people with diabetes. Diabetes Care. 2003;26:3333-41.

Apelqvist J, Agardh CD, Castenfors J, Stenström A, Agardh CD. Wound classification is more important than the site of ulceration in the outcome of diabetic foot ulcers. Diabet Med. 1989;6:526-30.

Cassar K, Bachoo P, Ford I, Greaves M, Brittenden J. Markers of coagulation activation, endothelial stimulation, and inflammation in patients with the peripheral arterial disease. Eur J Vasc Endovasc Surg. 2005;29:171-6.

Fejfarová V, Jirkovská A, Petkov V, Boucek P, Skibová J. Comparison of microbial findings and resistance to antibiotics between transplant patients, patients on hemodialysis, and other patients with the diabetic foot. J Diabetes Complications. 2004;18:108-12.

Fowler MJ. Microvascular and macrovascular complications of diabetes. Clin Diabetes. 2011;29:116-22.

Gensler SW, Haimovici H, Hoffert P, Steinman C, Beneventano TC. Study of vascular lesions in diabetic, nondiabetic patients: Clinical, arteriographic, and surgical considerations. Arch Surg. 1965;91:617-22.

Hope SA, Meredith IT. Cellular adhesion molecules and cardiovascular disease. I. Their expression and role in atherogenesis. Intern Med J. 2003;33:380-6.

Leskinen Y, Salenius JP, Lehtimäki T, Huhtala H, Saha H. The prevalence of peripheral arterial disease and medial arterial calcification in patients with chronic renal failure: Requirements for diagnostics. Am J Kidney Dis. 2002;40:472-9.

Nielsen LB. Atherogenicity of lipoprotein(a) and oxidized low-density lipoprotein: Insight from in vivo studies of arterial wall influx, degradation, and efflux. Atherosclerosis. 1999;143:229-43.

Pradhan AD, Rifai N, Ridker PM. Soluble intercellular adhesion molecule-1, soluble vascular adhesion molecule-1, and the development of symptomatic peripheral arterial disease in men. Circulation. 2002;106:820-5.

Raymakers JT, Houben AJ, Vd Heyden JJ, Tordoir JH, Kitslaar PJ, Schaper NC. The effect of diabetes and severe ischemia on the penetration of ceftazidime into tissues of the limb. Diabet Med. 2001;18:229-34.

Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH. Plasma concentration of C-reactive protein and risk of developing the peripheral vascular disease. Circulation. 1998;48.192-6.

Ridker PM, Stampfer MJ, Rifai N. Novel risk factors for systemic atherosclerosis: A comparison of C-reactive protein, fibrinogen, homocysteine, lipoprotein(a), and standard cholesterol screening as predictors of peripheral arterial disease. JAMA. 2001;285:2481-5.

Roldan V, Marin F, Lip GY, Blann AD. Soluble E-selectin in cardiovascular disease and its risk factors: A review of the literature. Thromb Haemost. 2003;90:1007-20.

Tzoulaki I, Murray GD, Lee AJ, Rumley A, Lowe GD, Fowkes FG. Inflammatory, hemostatic, and rheological markers for incident peripheral arterial disease: Edinburgh Artery Study. Eur Heart J 2007;28:354-62.