{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T04:53:33Z","timestamp":1777611213884,"version":"3.51.4"},"reference-count":17,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[1999,2,1]],"date-time":"1999-02-01T00:00:00Z","timestamp":917827200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Foot Ankle Int."],"published-print":{"date-parts":[[1999,2]]},"abstract":"<jats:p>Twenty diabetic patients underwent 22 dorsiflexion metatarsal osteotomies for treatment of chronic persistent or recurrent neuropathic forefoot ulcers. Mean duration of nonoperative treatment was 13 months. The procedure consisted of irrigation and debridement of the ulcer followed by basilar closing wedge metatarsal osteotomy performed through a dorsal approach. At follow-up, complete ulcer healing was noted in 21 cases (95%) at an average of 40 days postoperatively. Complications occurred in 15 cases (68%). The main problems encountered postoperatively were acute Charcot disease (32%) and deep wound infections (14%). Transfer lesions under adjacent metatarsal heads developed in two cases (9%). One ulcer (5%) failed to heal secondary to vascular insufficiency and eventually required a below the knee amputation after a failed revascularization attempt. Loss of screw fixation occurred in one patient (5%) but acceptable metatarsal alignment was maintained and the ulcer healed uneventfully. There were no cases of ulcer recurrence. The results of this study suggest that dorsiflexion metatarsal osteotomy is a reliable salvage procedure for the treatment of recalcitrant neuropathic forefoot ulcers that have failed an adequate trial of nonoperative treatment. This procedure is associated with a high complication rate, as would be expected in this patient population.<\/jats:p>","DOI":"10.1177\/107110079902000203","type":"journal-article","created":{"date-parts":[[2013,3,3]],"date-time":"2013-03-03T03:31:12Z","timestamp":1362281472000},"page":"80-85","source":"Crossref","is-referenced-by-count":93,"title":["Dorsiflexion Metatarsal Osteotomy for Treatment of Recalcitrant Diabetic Neuropathic Ulcers"],"prefix":"10.1177","volume":"20","author":[{"given":"James E.","family":"Fleischli","sequence":"first","affiliation":[{"name":"Carolinas Medical Center, Charlotte, North Carolina."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert B.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Miller Orthopaedic Clinic, Charlotte, North Carolina."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"W. Hodges","family":"Davis","sequence":"additional","affiliation":[{"name":"Miller Orthopaedic Clinic, Charlotte, North Carolina."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[1999,2]]},"reference":[{"key":"e_1_3_1_2_1","volume-title":"The diabetic footSurgery of the Foot and Ankle","author":"Brodsky J.W.","year":"1993","unstructured":"1. Brodsky J.W.: The diabetic foot. In Mann R.A. (ed.), Surgery of the Foot and Ankle, 6th Ed. St. Louis, C.V. Mosby, 1993.","edition":"6"},{"key":"e_1_3_1_3_1","first-page":"349","volume":"139","author":"Brower A.C.","year":"1981","unstructured":"2. Brower A.C., and Allman R.M.: Pathogenesis of the neuro-trophic joint: neurotraumatic vs. neurovascular. Radiology, 139: 349\u2013354, 1981.","journal-title":"Pathogenesis of the neuro-trophic joint: neurotraumatic vs"},{"key":"e_1_3_1_4_1","first-page":"214","volume":"9","author":"Dreeben S.M.","year":"1989","unstructured":"3. Dreeben S.M., Noble P.C., Hammerman S., Bishop J.O., and Tullos H.S.: Metatarsal osteotomy for primary metatarsal-gia: radiographic and pedobarographic study. Foot Ankle, 9:214\u2013218, 1989.","journal-title":"Metatarsal osteotomy for primary metatarsal-gia: radiographic and pedobarographic study"},{"key":"e_1_3_1_5_1","first-page":"147","volume":"42","author":"Gould J.S.","year":"1993","unstructured":"4. Gould J.S., Erickson S.J., Collier B.D., and Berstein B.M.: Surgical management of ulcers, soft-tissue infections, and osteomyelitis in the diabetic foot. Instr. Course Lect., 42:147\u2013158, 1993.","journal-title":"Surgical management of ulcers, soft-tissue infections, and osteomyelitis in the diabetic foot"},{"key":"e_1_3_1_6_1","first-page":"187","volume":"57","author":"Helal B.","year":"1975","unstructured":"5. Helal B.: Metatarsal osteotomy for metatarsalgia. J. 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Kitaoka H.B., and Patzer G.L.: Chevron osteotomy of lesser metatarsals for intractable plantar callosities. J. Bone Joint Surg., 80B: 516\u2013518, 1998.","journal-title":"Chevron osteotomy of lesser metatarsals for intractable plantar callosities"},{"key":"e_1_3_1_10_1","first-page":"465","volume":"19","author":"Lin S.S.","year":"1996","unstructured":"9. Lin S.S., Lee T.H., and Wapner K.L.: Plantar forefoot ulceration with equinus deformity of the ankle in diabetic patients: the effect of tendo-Achilles lengthening and total contact casting. Orthopedics, 19: 465\u2013475, 1996.","journal-title":"Plantar forefoot ulceration with equinus deformity of the ankle in diabetic patients: the effect of tendo-Achilles lengthening and total contact casting"},{"key":"e_1_3_1_11_1","first-page":"177","volume":"101","author":"Reikeras O.","year":"1983","unstructured":"10. Reikeras O.: Metatarsal osteotomy for relief of metatarsalgia. Arch. Orthop. 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