Panmetatarsal head resection in chronic neuropathic ulceration

Jacobs (1) reported use of the Clayton modification of the Hoffman procedure on 12 patients as the procedure of choice in select diabetics with abscess and ulceration. He described a dorsal transverse incision, amputation of all metatarsal heads, through-and-through drainage from a dorsal to plantar direction at the site of abscess formation, and use of a Jackson-Pratt drain dorso-laterally. The authors describe a modification of this procedure that has been performed for 6 years.