[Surgical treatment of diabetic malum perforans by ray resection]

The main cause of the diabetic perforating ulcer is peripheral neuro- and angiopathy. Trivial injuries of the foot, wounds (chiropody), bacterial or mycotic infections often lead to tissue defects in the form of a perforating ulcer (in which neuropathy predominates) or of gangrene (in which angiopathy predominates). The deeply penetrating trophic ulcer with secondary development of osteitis in the foot bones often present us with difficult therapeutic decisions. Several measures for its treatment are given in the literature. We report on 5 patients in whom a plantar perforating ulcer was present beneath the 2nd an 3rd metatarsal heads with radiologically confirmed osteitis. The entire ray, including the corresponding toe, is excised as a wedge from the plantar and dorsal aspects, and the wound left open to heal. The indications, the course of healing, the duration of hospital admission and the complications are described.