The Role of Medial Plantar Artery Flap in Heel Pad Reconstruction: A Report of Two Cases

Abstract

The heel and sole possess unique anatomical characteristics that serve a weight-bearing and shockabsorbing function. The heel is particularly vital, as any defects in this area can lead to gait instability. Reconstructing a heel defect presents challenges, as the donor flap must be durable enough to withstand high force loads while also providing protective sensation. Recently, the medial plantar artery flap has been successfully employed for the reconstruction of defective heel pads. This flap offers glabrous skin capable of weight transmission and intact protective sensation. In this report, we present two cases of heel pad loss secondary to chronic diabetic complications and trauma, respectively, which were treated with medial plantar artery flap reconstruction. Both cases were successfully treated, and they showed a good functional outcome.

Evaluation of Feasibility of Medial Plantar Artery Flap With Computed Tomography Angiography in Diabetic Patients: A Pilot Radioanatomic Study

“…The foot, specifically, plays a pivotal rile in facilitating fundamental activities like standing, walking, running, and jumping. With the increasing incidence of diabetic foot infections, more patients are at risk of losing their feet due to amputation [3][4][5][6]. It is anticipated that the prevalence of diabetes will be 4.4% in 2030 with a total of 366 million people living with diabetes [5][6][7].…”

“…With the increasing incidence of diabetic foot infections, more patients are at risk of losing their feet due to amputation [3][4][5][6]. It is anticipated that the prevalence of diabetes will be 4.4% in 2030 with a total of 366 million people living with diabetes [5][6][7]. Diabetic foot infection is ranked among the top 10 diseases that pose a heavy burden globally, with up to 30% of diabetic patients developing diabetic foot ulcers and an average of one leg amputation occurring every 20 seconds [8,9].…”

“…Recognizing the threat posed by diabetic foot infection, more resources are being channeled to tackle this problem [6][7][8][9][10]. Studies investigating the predictive factors of diabetic foot infection also provide guidance on how to preserve the lower limb in patients with this condition [3][4][5].…”

“…Studies investigating the predictive factors of diabetic foot infection also provide guidance on how to preserve the lower limb in patients with this condition [3][4][5]. The treatment of diabetic foot infections involves the surgical removal of the source of infection, isolation of causative pathogens, initiation of antibiotic treatment, optimization of host factors, and other adjunctive treatments [6][7][8][9][10]. Despite a better understanding of the pathophysiology and treatment of diabetic foot infection, one of the challenges encountered by the physicians treating these patients is wound healing [11][12][13][14][15][16][17].…”

“…A soft tissue defect resulting from a heel ulcer can be difficult to address due to limited reconstructive options and unique local area demand [13][14][15][16][17][18]. The loss of thick skin at the sole makes it challenging for a normal regional or distal flap to withstand the pressure of body weight [6,18]. The medial plantar artery flap is ideal for heel defect coverage as it provides thick, glabrous skin with good sensory feedback [6,18].…”