SLR - September 2022 - Vanisaben Patel, DPM PGY-3
Reference: García-Madrid M, García-Álvarez Y, Álvaro-Afonso FJ, García-Morales E, Tardáguila-García A, Lázaro-Martínez JL. Analysis of Plantar Pressure Pattern after Metatarsal Head Resection. Can Plantar Pressure Predict Diabetic Foot Reulceration? J Clin Med. 2021 May 24;10(11):2260.Level of Evidence: Level II
Scientific Literature Review
Reviewed By: Vanisaben Patel, DPM PGY-3
Residency Program: Bethesda Hospital East Boynton Beach, FL
Podiatric Relevance: In our field of medicine, wound care and forefoot concerns are a growing topic on a day-to-day basis and affect a majority of the patients we treat. With that in mind many of our patients have comorbidities that make them riskier candidates to develop wounds and pressure ulcers to their feet due to their biomechanical structure. This study was performed to evaluate the metatarsal head that was associated with the highest plantar pressure after metatarsal head resection (MHR) and the relationship with reulceration at one year
Methods: In this prospective study, 65 diabetic patient who underwent a first metatarsal head resection were included. At the time of inclusion they had an inactive ulcer, . For all patients the peak plantar pressure and pressure time integral were recorded at five specific locations in the forefoot: first, second, third, fourth, and fifth metatarsal heads. After resection of the first metatarsal head, there is a displacement of the pressure beneath the 2nd metatarsal.
Results: After resection of the first metatarsal head, there is a displacement of the pressure beneath the second metatarsal head. Following the resection of the minor metatarsal bones of the foot there was medial displacement of the plantar pressure. This was due to the displaced pressure from under the previous first metatarsal head and was mainly seen under the 2nd and 3rd head and then the 4th and 5th metatarsal head. At the one year follow up for all patients, the patients who has underwent the metatarsal resection in the first and 2nd metatarsal heads has continued to suffer from transfer lesion at the other heads with the highest pressure
Conclusion: Patients who underwent a minor metatarsal head resection overall showed a medial transference of pressure from the original first metatarsal head resection. Additionally, following the resection of the first metatarsal head there was a transference of pressure beneath the second metatarsal head. Increase of pressure was found to be a predictor of reulceration in cases of resection of the first and second metatarsal heads. Overall, transfer lesions are prominent when undergoing metatarsal head resection due to the biomechanic pressure change to the foot. For many patients these transfer lesion can result in nonhealing wounds or other issues due to their diabetic state. This article provides good insight regarding the effects of transfers lesions and how a surgeon must think of the pressure points that the patient may face later from the resection of the metatarsal heads.