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Surgical treatment of mal perforans
Abstract:
Mal perforans is a chronic foot ulcer commonly found in diabetics with neuropathy. Although it will often respond to conservative measures, recurrence is frequent and brings with it the risk of spreading infection and serious destruction of tissues. Surgical treatment of seven patients, based on excision of the distal metatarsal bone (five patients), or excision of the distal metatarsal and amputation of the first toe (two patients), gave satisfactory results and is indicated to achieve long-term healing. A special shoe, designed to remove pressure from the healing areas as well as from potential new pressure points, was used in the last four patients.
Insights
Surgical intervention for diabetic foot ulcers (mal perforans) involving metatarsal bone excision offers a durable solution. This approach, combined with specialized footwear, effectively manages chronic diabetic foot conditions and prevents recurrence.
Area of Science:
- Podiatry
- Diabetology
- Surgical Innovation
Background:
- Mal perforans ulcers are chronic diabetic foot conditions often linked to neuropathy.
- Conservative treatments have limited long-term success, with frequent recurrences posing risks of infection and tissue damage.
Purpose of the Study:
- To evaluate the efficacy of surgical management for recalcitrant mal perforans ulcers in diabetic patients.
- To assess the long-term healing outcomes of metatarsal bone excision and associated surgical techniques.
Main Methods:
- Surgical treatment of seven diabetic patients with mal perforans ulcers.
- Procedures included distal metatarsal bone excision (five patients) or combined with first toe amputation (two patients).
- Use of specialized pressure-relieving footwear in the latter four patients.
Main Results:
- Satisfactory healing results were achieved in all seven patients undergoing surgical intervention.
- The surgical approach demonstrated effectiveness in achieving long-term ulcer healing.
- The use of specialized shoes aided in managing pressure points during healing.
Conclusions:
- Surgical excision of the distal metatarsal bone, with or without first toe amputation, is indicated for long-term healing of mal perforans ulcers.
- This surgical strategy provides a viable solution for chronic diabetic foot ulcers unresponsive to conservative care.
- Adjunctive use of pressure-relieving footwear enhances treatment outcomes.