Plantar MTHs (13–14)

  • Dirk Hochlenert
  • Gerald Engels
  • Stephan Morbach
  • Stefanie Schliwa
  • Frances L. Game


Plantar lesions at the first (13) and those at the 2nd to 5th (14) metatarsal head (MTH) are treated in this chapter. These lesions are for many the epitome of a neuropathic diabetic foot. They do indeed show characteristic core aspects of the diabetic foot:
  1. 1.

    The atrophy of the plantar subcutaneous fat pad.

  2. 2.

    The dysbalance in muscle function with deformities and a damaging rise in plantar pressure while walking.

  3. 3.

    The usefulness of pressure-reducing footwear with optimised insoles and rocker bottom outsoles.

  4. 4.

    The presence of a typical pattern of calluses with subcutaneous haemorrhage before ulcers develop.



  1. 1.
    Brash PD, Foster J, Vennart W, Anthony P, Tooke JE. Magnetic resonance imaging techniques demonstrate soft tissue damage in the diabetic foot. Diabet Med. 1999;16(1):55–61.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Dirk Hochlenert
    • 1
  • Gerald Engels
    • 2
  • Stephan Morbach
    • 3
  • Stefanie Schliwa
    • 4
  • Frances L. Game
    • 5
  1. 1.Amb. Zentrum für DiabetologieEndoskopie & Wundheilung GemeinschaftspraxisKölnGermany
  2. 2.Department of Wound SurgerySt. Vinzenz Hospital and MVZ St. MarienKölnGermany
  3. 3.Department of Diabetes and AngiologyMarienkrankenhaus GmbHSoestGermany
  4. 4.Institute of Anatomy, Anatomy and Cell BiologyUniversity of BonnBonnGermany
  5. 5.Department of Diabetes and EndocrinologyDerby Hospitals NHS Foundation TrustDerbyUK

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