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