APMA Conference Coverage

Comparing Healing Outcomes After Floating Metatarsal Osteotomies and Metatarsal Head Resections in Diabetic Plantar Ulcers

Miranda Manier, BA

Key Highlights:

  • Healing rates for diabetic sub-metatarsal head ulcers were similar between floating metatarsal osteotomies (0.51 cm/week) and metatarsal head excisions (0.53 cm/week), with no statistically significant difference.
  • Higher HbA1c levels were significantly associated with slower healing in patients who underwent FMO, but not in those who had MHE.
  • Complication rates were comparable between procedures, though postoperative infections were observed only in the FMO group.

A study presented at the American Podiatric Medical Association 2025 Annual Scientific Meeting in Grapevine, TX investigated clinical outcomes in diabetic patients treated surgically for sub-metatarsal head ulcerations using either floating metatarsal osteotomies (FMO) or metatarsal head excisions (MHE). The goal was to compare healing rates using a modified version of Gilman’s equation (cm/week) and to assess complications, patient selection factors, and surgical considerations across multiple sites.

Diabetic foot ulcers are a significant clinical burden, affecting up to 25% of individuals with diabetes and frequently leading to infection, hospitalization, or amputation. Sub-metatarsal head ulcerations account for roughly 22% of diabetic foot ulcers. Surgical offloading procedures—FMO and MHE—are increasingly used after patients do not respond to nonoperative treatment. This study builds on previous literature suggesting that FMO may reduce plantar pressure and accelerate wound healing, while also being less invasive than traditional excisional techniques.

Researchers conducted a retrospective review from August 2021 to August 2023 across multiple hospitals. Inclusion criteria focused on patients with neuropathy and plantar ulcerations; exclusions included alternative surgical procedures or acutely infected patients. A total of 46 patients were included: 38 underwent FMO and eight underwent MHE. Healing rates were calculated using a modified Gilman’s equation to express weekly wound closure.

The average healing rates were 0.51 cm/week for FMO and 0.53 cm/week for MHE. An independent t-test showed no statistically significant difference between the groups (p = 0.05). One-way ANOVA demonstrated that higher HbA1c levels were significantly associated with slower healing in patients who underwent FMO (P = .033), a pattern not observed in the MHE group. Both cohorts had a higher proportion of men and underwent predominantly left-sided procedures. Complication rates were similar (P = .652), although postoperative infections occurred only in the FMO group.

Reported limitations include the retrospective design, small sample size (particularly for the MHE group), lack of a control group, variability in surgical technique between hospitals, and human error in wound measurement. The study also noted limited long-term follow-up.

“These results indicate that plantar metatarsal wounds heal at a rate of 0.51 cm/week despite higher HbA1c levels,” the authors concluded. “This promising result has the potential to prevent further diabetic amputations in those with HbA1c higher than the recommended maximum.”

Reference
Prasad S, Kubick S, Corcoran M, et al. A multi-center retrospective large case study: comparing wound healing rate utilizing modified Gilman’s equation with floating metatarsal osteotomies and metatarsal head resections to treat sub-metatarsal head ulcerations. Presented at: American Podiatric Medical Association (APMA) Annual Scientific Meeting; July 24–27, 2025; Graoevine, TX. https://www.apma.org/the-national/