title: Influence of Hallux Rigidus on Reamputation in Patients With Diabetes Mellitus After Partial Hallux Amputation.
abstract: Diabetic foot ulceration of the plantar hallux is a challenging condition and can require partial hallux amputation when complicated by infection. Lower extremity biomechanics play an important role in the development of hallux ulcers, and hallux rigidus (HR) could influence the outcomes after partial hallux amputation. We hypothesized that radiographic evidence of HR in patients with diabetes would be associated with greater ulcer recurrence and reamputation rates after partial hallux amputation. We performed a retrospective review of all patients with diabetes who had undergone a partial hallux amputation from January 2005 to December 2012. The subjects were divided into 2 cohorts according to the presence or absence of HR identified on preoperative radiographs. Baseline characteristics and outcomes were compared using a 2-sample Student's t test for continuous variables, and categorical variables were compared using the chi-square test for homogeneity and Fisher's exact test. A total of 52 patients were included, with 16 (31%) positive for radiographic evidence of HR at partial hallux amputation. Differences in the patient demographics and comorbidities were not significant between 2 cohorts with and without HR or reamputation. Reamputation was required in 5 subjects (31%) with HR and 2 (6%) without HR (p = .023). The average follow-up duration was 126 ± 89 weeks. Our results have demonstrated that the reamputation rate after partial hallux amputation is significantly greater in patients with than in those without radiographic evidence of HR. Surgeons should evaluate patients for HR when planning partial hallux amputation and use adjuvant methods of offloading when HR is evident to prevent recurrent ulceration and reamputation.
authors.affiliation: Staff Physician, Department of Podiatry, Ochsner Health System, New Orleans, LA.
authors.forename: Noah G
authors.initials: NG
authors.lastname: Oliver
authors.affiliation: Associate Professor and Division Chief, Department of Plastic Surgery, Georgetown University School of Medicine, Washington, DC.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Attinger
authors.affiliation: Associate Professor, Department of Plastic Surgery, Georgetown University School of Medicine, Washington, DC.
authors.forename: John S
authors.initials: JS
authors.lastname: Steinberg
authors.affiliation: Associate Professor, Department of Plastic Surgery, Georgetown University School of Medicine, Washington, DC.
authors.forename: Karen K
authors.initials: KK
authors.lastname: Evans
authors.affiliation: Resident, Department of Podiatry, Medstar Washington Hospital Center, Washington, DC.
authors.forename: David
authors.initials: D
authors.lastname: Vieweger
authors.affiliation: Associate Professor, Department of Plastic Surgery, Georgetown University School of Medicine, Washington, DC. Electronic address: Paul.J.Kim@gunet.georgetown.edu.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000379:methods*; D001696:Biomechanical Phenomena; D017719:Diabetic Foot / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006214:Hallux / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D020859:Hallux Rigidus / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies
keywords: diabetic foot ulcer; diabetic limb salvage; hallux limitus; infection; osteomyelitis; reulceration; surgical offloading