title: Evaluation of Hallux Interphalangeal Joint Arthroplasty Compared With Nonoperative Treatment of Recalcitrant Hallux Ulceration.
abstract: Patients with chronic diabetes can develop plantar hallux ulcerations secondary to neuropathy, increased pressure, and deformity. The present retrospective study evaluated the efficacy of hallux interphalangeal joint (HIPJ) arthroplasty to address recalcitrant ulceration. Two groups of patients with diabetes were compared: a surgical group of 13 patients and a nonsurgical standard therapy group of 13 patients. The patients in the surgical group underwent HIPJ arthroplasty. All the patients in the standard therapy group received local wound care and offloading. The mean duration of follow-up was 19.5 (range 1.2 to 47.9) months, and the mean age was 55 ± 13.0 years. Statistical significance was found in the surgical group for faster time to healing (3.5 weeks [2.5, 4.25] vs 9 weeks [2, 17.29], p = .033) and lower incidence of ulcer recurrence (8% ± 7.69 vs 54% ± 53.85, p = .031). There were also fewer amputations in the surgical group (0% ± 0 vs 38% ± 38.6, p = .063). To our knowledge, only 1 other published study has evaluated HIPJ arthroplasty as a treatment of recalcitrant hallux ulceration. The present study adds comparison data from a nonoperative standard therapy group and found that HIPJ arthroplasty is an effective curative treatment option to address chronic plantar hallux ulcerations in diabetic patients with neuropathy.
authors.affiliation: Resident, Podiatric Medicine and Surgery, Healthspan/Cleveland Clinic, Cleveland, OH. Electronic address: eric.j.lew@dmu.edu.
authors.forename: Eric
authors.initials: E
authors.lastname: Lew
authors.affiliation: Resident, Podiatric Medicine and Surgery, Healthspan/Cleveland Clinic, Cleveland, OH.
authors.forename: Nicole
authors.initials: N
authors.lastname: Nicolosi
authors.affiliation: Staff, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Patrick
authors.initials: P
authors.lastname: McKee
mesh_terms: D000671:Amputation, Surgical / Q000706:statistics & numerical data; D001178:Arthroplasty; D017719:Diabetic Foot / Q000628:therapy*; D003929:Diabetic Neuropathies / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D061826:Foot Orthoses; D006214:Hallux / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D014033:Toe Joint / Q000601:surgery*; D014945:Wound Healing
keywords: diabetes; hallux wound; limb salvage; neuropathy; offloading; toe preservation