Chronic Plantar Ulcer With Fourth Metatarsal Osteomyelitis

Clinical presentation, surgical treatment and documented healing.

01 / Problem: Clinical presentation
02 / Procedure: Surgical approach
03 / Outcome: Healing & follow-up

Clinical photographs below include wounds and surgical treatment.

01 / CLINICAL PRESENTATION

Problem

A 50-year-old man with type 2 diabetes, living abroad, presented with a chronic plantar ulcer of seven years’ duration. Despite prolonged conservative treatment, the wound failed to heal. Magnetic resonance imaging demonstrated osteomyelitis of the fourth metatarsal, identifying persistent bone infection as the underlying cause of the non-healing ulcer.

Chronic Plantar Ulcer With Fourth Metatarsal Osteomyelitis before image — Problem

02 / SURGICAL APPROACH

Procedure

Limb-sparing surgery was performed with complete resection of the infected fourth metatarsal and the proximal phalanx of the fourth toe until healthy, bleeding bone margins were obtained. The surrounding viable plantar soft tissues were preserved to provide durable biological coverage of the surgical defect and facilitate healing by secondary intention.

03 / HEALING & FOLLOW-UP

Outcome

Complete wound healing was achieved in approximately three months.

This case demonstrates that even a longstanding plantar ulcer of seven years can heal rapidly once the underlying osteomyelitis is surgically eradicated. Targeted bone resection eliminated the source of chronic infection, preserving a functional, weight-bearing foot while avoiding major amputation.