DISTAL MINIMALLY INVASIVE OSTEOTOMY (DMDO)
- Method
- Percutaneous osteotomy of the metatarsal to take pressure off
- Duration
- 20 to 40 minutes
- Recovery time
- 6 to 12 weeks
The distal minimally invasive diaphyseal osteotomy – DMDO for short – takes the pressure off a wound under the ball of the foot without opening the wound itself. It is used in diabetic foot syndrome when an ulcer under a metatarsal head fails to heal despite footwear, insoles and wound care.
The cause of such an ulcer is almost always mechanical: one metatarsal sits lower than its neighbours and carries more load with every step than the skin above it can take. As long as that pressure peak remains, the wound does not heal for good – it returns to the same spot after every apparent recovery.
How the operation proceeds
Through an opening a few millimetres wide on the top of the foot, a fine burr is guided to the metatarsal. Under fluoroscopic control the bone is divided obliquely – a little above the head, in the shaft. The cut therefore lies outside the area of the wound, which in the diabetic foot is often colonised by bacteria.
The head is then no longer held rigidly and moves upwards and backwards under load. It finds the height at which the load is spread evenly across all the metatarsal heads. Nothing is fixed in place: no screws and no plates remain in the foot for an infection to settle on.
When a DMDO is considered
We suggest the operation when a wound under a metatarsal head has persisted for weeks or keeps returning despite offloading – and when the circulation is good enough for the bone to heal. If there is infection in the bone, that is treated first.
The operation also makes sense as a preventive measure where the skin keeps forming a callus at one spot and is close to breaking down. Take the pressure away beforehand and the wound never forms. Where the wound lies under the fifth metatarsal head, we often include the neighbouring bones – otherwise the pressure peak simply moves next door.
Aftercare following a DMDO
The foot may be loaded again early – one of the advantages of the technique. What matters are the postoperative shoe and regular checks of the wound.
Phase I (0–2 weeks): Postoperative shoe and wound checks
- Weight-bearing in the postoperative shoe from day one, as far as the wound allows
- Regular change of dressings, checks on how the wound is doing
- Elevation and cooling against the swelling
- Thrombosis prophylaxis as prescribed
Phase II (2–6 weeks): Bone healing
- Postoperative shoe continued, weight-bearing as comfort allows
- X-ray check to judge the position of the metatarsal head
- Measures to reduce swelling, lymphatic drainage where needed
- Preparing the fitting of insoles or footwear
Phase III (from week 6): Back into an everyday shoe
- Transition into the fitted everyday or custom-made shoe
- Continue looking at the foot every day
- Regular follow-up so that a new pressure point is picked up early
Our foot specialists
Experienced specialists in minimally invasive foot surgery and the diabetic foot
