Modified resection arthroplasty for infected non-healing ulcers with toe deformity in diabetic patients.
BACKGROUND
Diabetic motor neuropathy is expressed as the loss of function and the contracture of the intrinsic muscles of the foot, leading to the classic claw toe deformity. This deformity predisposes the foot to ulcerations on the dorsum or tip of the toes or an interdigital ulcer over a condyle between the toes. We present our results of a modified resection arthroplasty for the treatment of this difficult problem.


METHODS
In this study, 72 toes (57 feet) with a deformity in the second to fifth toe accompanied by chronically infected ulcers were involved. All patients underwent modified resection arthroplasty of the PIP or DIP joint depending on the ulcer location. The second toe was involved in 27 cases (38%), the third toe in 11 cases (15%), the fourth toe in 19 cases (26%), and the fifth toe in 15 cases (21%). With the exception of 4 patients, all had a positive culture, including 7 cases of MRSA. The mean followup was 28.7 +/- 8.1 months.


RESULTS
The mean wound healing time was 25.6 +/- 6.2 days. Three cases eventually required toe amputation but there was no proximal spread of infection. No recurrence of a claw toe or ulcer occurred in the remaining toes.


CONCLUSIONS
We believe that modified resection arthroplasty for toe deformities with chronic infected ulcers in diabetic patients is a good treatment alternative to toe amputation.
Department of Orthopedic Surgery, Eulji University Hospital, Seoul, South Korea. kjyos@yahoo.co.kr
J-Young
JY
Kim
Tae Wan
TW
Kim
Young Eun
YE
Park
Yoon Jung
YJ
Lee
D000368:Aged; D001178:Arthroplasty / Q000379:methods*; D015331:Cohort Studies; D017719:Diabetic Foot / Q000150:complications / Q000601:surgery*; D005260:Female; D005531:Foot Deformities, Acquired / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000150:complications / Q000601:surgery; D013203:Staphylococcal Infections / Q000150:complications / Q000601:surgery; D014033:Toe Joint; D016896:Treatment Outcome; D014945:Wound Healing