A 69-year-old man with type 2 diabetes of 22 years' duration and peripheral neuropathy had a history of chronic full-thickness ulceration beneath his left 1st metatarsal head. The ulcer did not probe to bone (Fig. 8.11). Radiographs revealed a hypertrophic tibial sesamoid (Fig. 8.12). Conservative treatment was employed for 4 months with no improvement in his condition. The patient was offered the option of surgical treatment and he consented. In this case, the plantar ulcer was excised and both medial and lateral sesamoids were removed (Fig. 8.13a,b). The wound was packed open and allowed to heal by secondary intention.
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