Randomized comparative study between metatarsal head resection and total contact cast in the treatment of diabetic plantar forefoot ulcer

Objective
The present study assessed and compared the efficacy of metatarsal head resection (MHR) compared with total contact cast (TCC) in the treatment of neuropathic diabetic foot ulcers located at the plantar surface of metatarsal heads.
Materials and methods
Between January 2017 and September 2019, this prospective, randomized, comparative study was performed at Menoufia University −Hospitals. One hundred patients suffering from solitary planter forefoot neuropathic ulceration were assigned into two groups: the first group was treated by MHR and the second group was treated by TCC. Wound healing was the primary outcome while ulcer recurrence and complications were the secondary outcomes of this study.
Results
Baseline patient characteristics were comparable in both groups. Both intention-to-treat and per-protocol analysis were used to evaluate ulcer healing during the treatment period. Percentage of ulcers healed within 12 weeks was 82 and 58% for MHR and TCC groups, respectively (<0.05). Mean time to heal was significantly shorter in MHR compared with TCC (6.31±1.77 vs 7.48±1.72 weeks, <0.05). Reduction in ulcer area after 2 weeks was (25.4±9.9 and 17.4±8.5%) in MHR and TCC, respectively (<0.05). Reduction in ulcer area was (57.7±21.6 and 44.2±22%) in MHR and TCC after 4 weeks of treatment (<0.05). Complications including infection, deformity, toe ischemia, falls, blister, abrasion, or pressure points were comparable in the two treatment groups.
Conclusion
Being an invasive procedure, MHR offers a safe effective offloading option with higher healing potential and lower recurrence rate compared with TCC as the standard offloading modality.