Proximal Derotation Phalangeal Osteotomy for Medial First Toe Diabetic Ulcer.

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. © Indian Orthopaedics Association 2020.