2026 Volume 7 Issue 1 Pages 52-58
Surgical offloading should be considered for chronic, recurrent ulceration that is resistant to non-surgical interventions in deformed, insensate feet. We report two cases of adults with residual clubfoot deformities accompanied by spina bifida who underwent different types of surgical offloading. In both cases, the ulcerated feet were insensate and had residual forefoot adduction and inversion deformities. Case 1 was a female patient who had undergone pantalar arthrodesis of the right foot at the age of 22. She developed recalcitrant ulceration on the lateral midsole and a recurrent fistula on the lateral heel. At age 35, she underwent removal of the ulcerated tissue and protruding infected bone, followed by free LD musculocutaneous flap transfer. She subsequently underwent four additional exostectomies for recurrent ulcers, which resulted in a reduction in the size of the foot. At the age of 53, she had been free of ulcer recurrence for three years. Case 2 was a male patient with AMC who had undergone multiple operations on his left foot, including triple arthrodesis. Despite three additional surgeries for recurrent ulcers with osteomyelitis, he continued to have an intractable ulcer beneath the 5th metatarsal head. At age 27, a midtarsal osteotomy was performed to correct the residual deformity. He remained free of ulcer recurrence for three years thereafter. Our findings suggest that early corrective osteotomy is preferable to exostectomy.