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Proximal Derotation Phalangeal Osteotomy for Medial First Toe Diabetic Ulcer
Ezequiel Palmanovich1,2, Nissim Ohana1,2, Omer Slevin1,2
1Orthopedic Department, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel.
Background:
Foot ulcers are a common complication in diabetic patients. Mild callus formation due to a plantar pressure can lead to an ulcer formation with potentially hazardous sequelae. Eliminating the pressure from the ulcer is essential for a proper healing process. Proximal derotation phalangeal osteotomy is a relatively simple procedure that can redistribute the planter pressure points over the hallux.
Methods:
Thirteen patients underwent proximal derotation phalangeal osteotomy to relieve the bony pressure causing an ulcer in the first toe, which was refractory to non-operative treatment. Twelve patients had diabetes type 2 and one had Charcot-Marie-Tooth disease.
Results:
Ulcers were completely resolved in all 13 patients in an average time of 4.3 (range 2-8) weeks. Four patients (31%) had mild complications that resolved well. No further surgery was required at 1-year follow-up.
Conclusion:
Proximal derotation phalangeal osteotomy enabled ulcer healing in refractory cases.
Level Of Evidence:
Level III retrospective study.
