Distal Metatarsal Osteotomies (DMOs) for Diabetic Foot

Background. It is estimated that in 2021, 10.5% of the adult population aged between 20 and 79 years worldwide will suffer from type 1 or type 2 diabetes and that its prevalence is set to increase by more than 45 % over the next twenty-five years. Among them, about 15% develop, during their lives, complications in the lower limbs and in particular in the foot, up to the development of plantar ulcers, the pathogenesis of which is closely related to peripheral neuropathy, microvascular alterations and altered plantar pressure, typical of diabetic patients. In fact, it is estimated that about half of all hospitalisations due to the complications of diabetes are related to the diabetic foot and that chronic plantar ulcer is the leading cause of non-traumatic lower limb amputation. The standard therapy for plantar ulcers is conservative, however, when this fails, it can easily lead to amputation. In this context, minimally invasive distal osteotomy of the metatarsals (DMO) is proposed as a therapeutic alternative in case of failure of conservative treatments, in order to re-establish a more balanced plantar pressure by promoting ulcer healing and preventing ulcer recurrence or preventing the progression of pre-ulcerative lesions. Purpose of the study. This prospective study aims mainly to analyse the clinical and functional, radiological, surgical results and degree of subjective satisfaction in the medium to long-term of patients diagnosed with metatarsalgia biomechanics in association or not with hallux valgus treated at the orthopaedic clinic and trauma Padua using minimally invasive technique (MIS). While, the secondary purpose is to evaluate the effectiveness of this percutaneous surgery, comparing the results obtained with those available in the literature. Materials and methods. They were taken into account patients operated on between January 2014 and December 2019 by inserting them progressively according to specific inclusion and exclusion criteria. data on their characteristics were also collected (gender, age, dominant hand, comorbidity, anesthetic ASA class, smoking), the type of preulcerative/ulcerative lesion (affected side, size, presence/absence of ischemia and/or infection, UTDWCS classification, time to heal) and to treatment performed (number of engraved metatarsals, complications present). Radiographically, all the patients were observed before and after surgery to assess the time to healing of the osteotomies and the possible recovery of the metatarsal formula. The average to long-term results were evaluated with the following scales: EFAS, 17-FFI, MOXFQ, SF-36 and VAS for satisfaction.