The most commonly employed procedure for the treatment of chronic neuropathic ulceration involves excision of bony prominences through either a plantar, medial or lateral approach. Decompression of the ulcer may be sufficient to prevent recurrence even when there is
residual deformity of the foot. Excision of the ulcer, resection of underlying bony prominence, with primary or secondary closure of the wound, is a reasonable method of treatment associated with minimal morbidity.
The surgical approach to ostectomy can be direct or indirect, and is determined by the location of deformity and condition of the skin. Bone can be resected through a plantar approach: however, it is easier to do this through either a medial (Fig. 8.35) or lateral (Fig. 8.36a,b) approach. Excision of the ulcer with resection of bone provides a quick fix for chronic plantar ulceration: however, recurrence is common.
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