(CS-118) Effectiveness of Osteoclasis in Distal Diabetic Foot Ulcers

Joshua Choi, DPM – Resident, Surgery, Boston Medical Center; Subin Siby, DPM – Podiatric Resident, Surgery, Boston Medical Center; Olivia Chandler, Medical Student; Edward Chen, Medical Student; Ewald Mendeszoon, DPM – Attending Physician, Surgery, Boston Medical Center; Wei Tseng, DPM – Attending Physician, Surgery, Boston Medical Center

Introduction: The National Diabetes Statistics in 2021 estimated that 38.4 million people had diabetes. The change in foot morphology affects the plantar pressure at the metatarsal heads, causing a callus that can become an ulcer (1,2). The lifetime risk of developing a foot ulcer in patients with diabetes is more than 33%. About two-thirds of diabetic foot ulcers will eventually heal, but approximately 28% may result in some form of lower extremity amputation. The steps to successful treatment include debridement, prevention of infection, appropriate dressings, keeping blood sugar levels under control, maintaining blood flow, and offloading (3). Surgical offloading is effective in preventing and healing Diabetic foot ulcers. We present a procedure called osteoclasis and aim to show its effectiveness.

Methods: We present two reports of patients with chronic distal foot ulcers.

Case One: The patient is a 60-year-old female with diabetes mellitus, peripheral neuropathy, and a history of chronic neuropathic ulceration presents with a chronic recurrent ulcer beneath the third metatarsal head of the right foot. She was taken to the operating room; an incision was made dorsally over the third metatarsal head of the right foot, and a 0.5 cm collar of bone was removed from the anatomic neck of the third metatarsal.

Case Two: The patient is a 63-year-old male with diabetes, peripheral neuropathy, and chronic kidney disease presented with chronic recurrent ulcers under the left metatarsal head two and three. He was taken to the operating room; with a dorsal approach, a 3-millimeter collar of bone was removed from the second and third metatarsals.

Results: The surgical site and the ulcer healed in six weeks for case one and ten weeks for case two. There were no complications, and no amputation was needed.

Discussion: Osteoclasis involves making an osteotomy at the distal metatarsal where the ulcer is present to allow the metatarsal head to move upward and reduce the pressure on the ulcer. Some surgeons also take a thin slice of the metatarsal at the osteotomy site. Tseng et al. showed that the procedure was safe and effective compared to metatarsal head resection (4).