Heberprot-P® and Metatarsal Osteotomy in the Advanced Treatment of Diabetic Foot

Abstract

Introduction: Diabetes mellitus is a common pathology affecting the foot, with neuropathic ulcers being a frequent presentation.

Objective: To describe the effectiveness of Heberprot-P^® therapy in combination with metatarsal osteotomy in diabetic patients with plantar neuropathic ulcers (uncomplicated mal perforans).

Methods: A descriptive observational study was conducted at the Hospital Provincial General Docente “Dr. Antonio Luaces Iraola” in Ciego de Ávila from February 2022 to February 2024. The study included diabetic patients with neuropathic ulcers in the forefoot who underwent offloading surgery via metatarsal osteotomy and received intralesional Heberprot-P^® as an adjuvant treatment. A total of 58 patients were included.

Results: Lesions were located in the area of the first metatarsal bone (31.0%), the third metatarsal bone (43.1%), and the fifth metatarsal bone (25.9%). Treated lesions were classified as Wagner grade 2 (55.2%) and Wagner grade 3 (44.8%). The most frequent complications were local cellulitis (15.5%) and local hematoma (12.1%). Fifty-seven percent of patients achieved epithelialization between 20 and 29 days following surgery with intralesional Heberprot-P^® treatment.

Conclusions: The combined treatment of metatarsal osteotomy and Heberprot-P^® in neuropathic ulcers demonstrates a low percentage of complications and a faster epithelialization process, offering a viable and beneficial solution for the management of diabetic foot complications.