Our Summary

This research paper discusses a surgical procedure called minimally invasive distal metatarsal diaphyseal osteotomy (DMDO) which is a useful method in treating complex, chronic foot ulcers in diabetic patients. This procedure is especially effective for ulcers that are resistant to other treatments, and for recurring pressure ulcers.

The major advantages of DMDO for diabetic patients include very small surgical scars and minimal tissue damage. Patients can bear weight on their foot immediately after the surgery, and there’s no need for metal fixation which could potentially cause post-surgery infections. The procedure also helps to reduce high pressure on the sole of the foot by restoring a balanced foot arch, and this aids in the rapid healing of ulcers.

FAQs

  1. What is minimally invasive distal metatarsal diaphyseal osteotomy (DMDO)?
  2. What are the advantages of DMDO for diabetic patients?
  3. Can DMDO be used to treat resistant toe ulcers and recurrent pressure ulcers?

Doctor’s Tip

A helpful tip that a doctor might tell a patient about minimally invasive surgery is that it often results in less pain, faster recovery time, and minimal scarring compared to traditional open surgery. Additionally, patients may experience fewer complications and be able to resume normal activities sooner. It is important to follow post-operative instructions carefully to ensure the best outcome.

Suitable For

Patients who are typically recommended minimally invasive surgery for diabetic foot ulcers under the heads of all lateral metatarsal bones, resistant toe ulcers, and recurrent pressure ulcers include those with:

  1. Complicated chronic diabetic foot ulcers
  2. Resistant toe ulcers
  3. Recurrent pressure ulcers
  4. High plantar pressures
  5. Neuropathic ulcers

These patients can benefit from the advantages of minimally invasive surgery, such as minimal surgical scars and tissue damage, immediate postoperative weight bearing, absence of metal fixation, reduction of plantar pressures, and rapid ulcer healing.

Timeline

Before minimally invasive surgery:

  • Patient presents with chronic diabetic foot ulcers under the heads of lateral metatarsal bones
  • Resistant toe ulcers and recurrent pressure ulcers are present
  • High plantar pressures and imbalanced forefoot arch may be observed
  • Patient may have tried other conservative treatments without success

After minimally invasive surgery:

  • Patient undergoes minimally invasive distal metatarsal diaphyseal osteotomy (DMDO)
  • Minimal surgical scars and tissue damage are observed
  • Patient is able to bear weight immediately postoperatively
  • Absence of metal fixation reduces risk of infection
  • Restoration of harmonic balanced forefoot arch reduces plantar pressures
  • Ulcer healing is rapid postoperatively

What to Ask Your Doctor

  1. What specific benefits can I expect from undergoing minimally invasive distal metatarsal diaphyseal osteotomy (DMDO) for my diabetic foot ulcer?

  2. How long is the recovery time after undergoing DMDO surgery?

  3. Are there any potential risks or complications associated with minimally invasive DMDO surgery?

  4. Will I be able to bear weight on my foot immediately after the surgery?

  5. How long will it take for my ulcer to heal after undergoing DMDO surgery?

  6. Will I need any additional treatments or follow-up care after the surgery?

  7. Are there any restrictions on activities or footwear that I should be aware of after undergoing DMDO surgery?

  8. How experienced are you in performing minimally invasive DMDO surgeries for diabetic foot ulcers?

  9. Can you provide me with information on the success rates of DMDO surgery for diabetic foot ulcers?

  10. Are there any alternative treatment options available for my diabetic foot ulcer that I should consider before undergoing DMDO surgery?

Reference

Authors: Biz C, Ruggieri P. Journal: Foot Ankle Clin. 2020 Sep;25(3):441-460. doi: 10.1016/j.fcl.2020.05.006. Epub 2020 Jul 9. PMID: 32736741