Radiation therapy for prevention of recurrent heterotopic ossification following partial metatarsal ray resection [poster]
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Heterotopic ossification (HO) formation is a relatively common yet overlooked cause of re-ulceration following previous partial foot amputation. Excessive bone growth at partial metatarsal ray resection sites has the potential to create unwanted prominences on the weight-bearing surface of the foot, placing the neuropathic patient at higher risk for re-ulceration and limb-loss. The goal of this study was to assess the efficacy of radiation therapy in preventing recurrent HO. A retrospective chart and radiographic review was performed on patients with a history of partial metatarsal amputation who subsequently developed HO and underwent additional surgery for resection of the HO with prophylactic radiation therapy. A staging system was developed to assess the radiographic severity of HO formation and associated clinical manifestations. Six-week postop radiographic recurrence rate and corresponding staging were assessed independently by a foot and ankle surgeon and resident. Twelve consecutive patients met the criteria for inclusion. One patient exhibited lowgrade (Grade 1a) heterotopic bone re-growth with no associated ulceration at six weeks postoperatively for a recurrence rate of 8%. Ten patients (83%) exhibited HO-related ulceration preoperatively while no patients exhibited ulcer recurrence postoperatively. Inter-rater reliability between investigators exhibited 100% agreement in HO presence and staging (.=1). The role of HO formation in neuropathic ulcer pathogenesis is a relatively common yet frequently overlooked finding despite its potential for significant adverse effects. Based on our findings, radiation therapy provides an efficacious option for the prevention of HO formation as an adjunct to standard diabetic limb salvage techniques.