J Korean Foot Ankle Soc.  2024 Dec;28(4):146-151. 10.14193/jkfas.2024.28.4.146.

Treatment of Diabetic Bunionette Deformity with Ulcer Using S.E.R.I. (simple, effective, rapid, and inexpensive) Operation

• Lee J
• Chung JW

• KMID: 2562451
• DOI: http://doi.org/10.14193/jkfas.2024.28.4.146

Abstract

Purpose
Forefoot ulcers have been implicated as a causative factor in diabetic foot amputation. The treatment of a bunionette deformity with an ulcer is not well established. This study examined the outcomes of a S.E.R.I. (simple, effective, rapid, and inexpensive) operation for bunionette deformity with ulcers in diabetic neuropathy.
Materials and Methods
Between January 2014 and June 2022, 20 patients (20 feet) treated for the bunionette deformity with a S.E.R.I. operation were reviewed retrospectively. All patients had diabetic neuropathy. Eleven patients were female, and the mean age at the time of surgery was 62 years. The mean follow-up time was 16 months. Radiologically, the 4th, 5th intermetatarsal angle (4, 5 IMA), lateral deviation angle (LDA), and the length of the 5th metatarsal bone were analyzed preoperatively and after a 1-year follow-up, and the clinical healing time of the ulcer was also reviewed.
Results
The 4, 5 IMA and LDA were reduced from the mean preoperative values of 11.4° and 7.9° to 4.8° and 3.8°, respectively (p<0.05). The mean 5th metatarsal length was reduced from 64.3 mm to 61.2 mm (p<0.05). All ulcers were healed at 3 months with no recurrence at the final follow-up. Four patients showed delayed union, and nine patients had developed hard corn around the previous lesion.
Conclusion
The S.E.R.I. operation can be an acceptable treatment modality for bunionette deformity with an ulcer who has diabetic neuropathy by offloading the bunionette so that ulcer healing can occur.

Keyword

Bunionette; Diabetic foot; Ulcer; S.E.R.I. operation

Figure

• 

  Figure 1 Radiographs and photographs of a 57-year-old female patient who has diabetic neuropathy with bunionette. Preoperative standing anteroposterior radiograph shows type II bunionette deformity by Fallat (A). Radiograph after S.E.R.I. operation (B). At postoperative 3 months, the radiograph shows bony union of the osteotomy site (C). Preoperatively, a grade 1 ulcer developed at the lateral side of the 5th metatarsal head (D). At postoperative 3 months, the healing of the ulcer was confirmed (E). S.E.R.I., simple, effective, rapid, and inexpensive.

• 

  Figure 2 Radiographs and photographs of a 62-year-old male patient who has diabetic neuropathy with bunionette. Preoperative medial oblique radiograph shows type IV bunionette deformity by Fallat with soft tissue defect at the lateral side of the 5th metatarsal head (A). S.E.R.I. operation was performed at the proximal shaft (B). At postoperative 6 months, radiograph shows bony union of the osteotomy site (C). Preoperatively, a grade 2 ulcer developed at the lateral side of the 5th metatarsal head (D). At postoperative 6 months, the healing of the ulcer was confirmed, but hard corn was newly developed around the previous osteotomy site (E). S.E.R.I., simple, effective, rapid, and inexpensive.

• 

  Figure 3 Radiographs of a 67-year-old male patient who has diabetic neuropathy with bunionette. Preoperative standing anteroposterior radiograph shows type III bunionette deformity by Fallat (A). S.E.R.I. operation was performed but radiograph shows metatarsal shortening due to over-correction (B). At postoperative 6 months, radiograph shows atrophic nonunion of the osteotomy site (C). But the bony union was achieved at the 12 months follow-up (D). S.E.R.I., simple, effective, rapid, inexpensive.

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