title: Excision arthroplasty: an effective method in the management of plantar ulcers with metatarsophalangeal joint infection in anaesthetic feet.
abstract: The cases of 30 patients with septic arthritis of the metatarsophalangeal (MTP) joints as a complication of plantar ulceration in leprosy who underwent excision arthroplasty and primary closure of the plantar ulcer were reviewed. Twenty-two of these patients were male. The commonest site of MTP joint involvement was the first MTP joint. The average longitudinal diameter of ulcers was 2cm, and most ulcers were oval in shape. Diagnosis was made on the basis of signs of infection over the MTP joint, discharge from the ulcer and examination with a probe. Infection in the joint ranged from simple synovial discharge to seropurient or purulent discharge. Treatment involved excision arthroplasty of the MTP joint, excision of the ulcer with primary closure of the plantar incision and dorsal or lateral drainage depending upon the direction in which the infection extended. In two patients, the plantar wound could not be closed as it was too large. Healing of the plantar incision took 2 weeks in 12 patients and 3 weeks in 14 patients. In four patients, healing did not occur by primary intention. In a follow up of 1-2 years, there was no recurrence in 24 patients, while four patients had recurrent simple ulceration. Two patients were lost to follow up. Review of the results of this procedure dealing with septic arthritis of MTP joints secondary to plantar ulceration shows that primary healing of the plantar incision could be achieved in 3 weeks. With regard to recurrence, even though only four out of 28 ulcers treated by this procedure recurred, other contributing factors should be considered in a prospective control study to support the view that this procedure has contributed to non-recurrence.
authors.affiliation: Department of Surgery, Schieffelin Leprosy Research and Training Centre, Karigiri, Tamil Nadu, India.
authors.forename: Anil Thomas
authors.initials: AT
authors.lastname: Oommen
authors.forename: Ebenezer
authors.initials: E
authors.lastname: Mannam
authors.forename: S
authors.initials: S
authors.lastname: Partheebarajan
authors.forename: Solomon
authors.initials: S
authors.lastname: Samuel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001170:Arthritis, Infectious / Q000209:etiology / Q000601:surgery*; D001178:Arthroplasty / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D016523:Foot Ulcer / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007918:Leprosy / Q000150:complications*; D008297:Male; D008683:Metatarsophalangeal Joint / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D020886:Somatosensory Disorders / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology