Outcome of Helal osteotomy for chronic plantar foot ulcers

Abstract

Category: Diabetes Introduction/Purpose: Chronic ulceration of the forefoot is a major problem in neuropathic and diabetic feet. Foot ulceration represents a risk factor for the development of osteomyelitis and increases the risk of amputation.The purpose of this study was to evaluate the effectiveness of Helal osteotomies concerning the development of plantar foot ulcers. Methods: Eighteen patients with a mean age of 69 years (min 55 yr, max 85 yrs) suffering from chronic, refractory ulcerations of the forefoot underwent Helal osteotomies. Demographic parameters, radiologic parameters, ulcer classification, complications, ulcer recurrence and ulcer healing were documented.The ulcerations were assessed according to the Wagner Armstrong classification. Results: The mean follow up was 30 months (min 6, max 68 months). Preoperatively, there were 3 grade 1A, 1 grade 1B,5 grade 2A, 8 grade 2B and 1 grade 3B ulcers. The most common site of ulceration was the MTP 3 joint, followed by the MTP 2 joint. All ulcers recovered with a mean healing time of 5.5 weeks (min: 1 week, max. 12 weeks). One ulcer recurred due to a secondary ossification of the osteotomy. After a reosteotomy, a permanent healing of the ulcer was achieved. There were 4 complications (1 hematoma, 2 wound infections, 1 ossification), of which only the ossification required revision surgery. Conclusion: The Helal osteotomy is a safe and effective method in treating neuropathic forefoot ulcerations. The procedure allows for rapid mobilization of the patient.