Evaluation of Hallux Interphalangeal Joint Arthroplasty Compared With Nonoperative Treatment of Recalcitrant Hallux Ulceration

Lew, Eric; Nicolosi, Nicole; McKee, Patrick A.

doi:10.1053/j.jfas.2014.08.014

Cited by 21 publications

(40 citation statements)

References 7 publications

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“…Other clinicians have good results with their procedures (e.g. hallux interphalangeal arthroplasty for ulcers under the interphalangeal joint [ 31 ]). The innovation in this protocol is the semi-crossover design.…”

Section: Discussionmentioning

confidence: 99%

“…Our team at Assaf HaRofeh has recently published successful results for several offloading surgical procedures [ 15 , 18 , 29 , 30 ] as have other clinicians with other procedures [ 31 ]. Our standard management included clinical assessment of the foot deformity before and after surgery to see how well the deformity had been corrected.…”

Section: Introductionmentioning

confidence: 99%

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Surgical offloading procedures for diabetic foot ulcers compared to best non‐surgical treatment: a study protocol for a randomized controlled trial

Finestone

Tamir

Ron

et al. 2018

Journal of Foot and Ankle Research

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BackgroundDiabetic foot ulcers are frequently related to elevated pressure under a bony prominence. Conservative treatment includes offloading with orthopaedic shoes and custom made orthotics or plaster casts. While casting in plaster is usually effective in achieving primary closure of foot ulcers, recurrence rates are high. Minimally invasive surgical offloading that includes correction of foot deformities has good short and long term results. The surgery alleviates the pressure under the bony prominence, thus enabling prompt ulcer healing, negating the patient’s dependence on expensive shoes and orthotics, with a lower chance of recurrence. The purpose of this protocol is to compare offloading surgery (percutaneous flexor tenotomy, mini-invasive floating metatarsal osteotomy or Keller arthroplasty) to non-surgical treatment for patients with diabetic foot ulcers in a semi-crossover designed RCT.MethodsOne hundred patients with diabetic neuropathy related foot ulcers (tip of toe ulcers, ulcers under metatarsal heads and ulcers under the hallux interphalangeal joint) will be randomized (2:3) to a surgical offloading procedure or best available non-surgical treatment. Group 1 (surgery) will have surgery within 1 week. Group 2 (controls) will be prescribed an offloading cast applied for up to 12 weeks (based on clinical considerations). Following successful offloading treatment (ulcer closure with complete epithelization) patients will be prescribed orthopaedic shoes and custom made orthotics. If offloading by cast for at least 6 weeks fails, or the ulcer recurs, patients will be offered surgical offloading. Follow-up will take place till 2 years following randomization. Outcome criteria will be time to healing of the primary ulcer (complete epithelization), time to healing of surgical wound, recurrence of ulcer, time to recurrence and complications.DiscussionThe high recurrence rate of foot ulcers and their dire consequences justify attempts to find better solutions than the non-surgical options available at present. To promote surgery, RCT level evidence of efficacy is necessary.Trial registrationIsrael MOH_2017–08-10_000719. NIH: NCT03414216.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Surgical offloading procedures for diabetic foot ulcers compared to best non‐surgical treatment: a study protocol for a randomized controlled trial

Finestone

Tamir

Ron

et al. 2018

Journal of Foot and Ankle Research

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“…In contrast, others have considered open ulcerations to be a contraindication for HIPJ fusion (5). Others have suggested Keller arthroplasty (18) or HIPJ arthroplasty (19) for hallux interphalangeal joint ulcerations. Given the high complications with HIPJ arthrodesis in the presence of PN, arthroplasty might be a reasonable alternative for these patients because it does not demand fusion of bone.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Hallux Interphalangeal Joint Arthrodesis Fixation Techniques: A Retrospective Multicenter Study

Thorud

Jolley

Shibuya

et al. 2016

The Journal of Foot and Ankle Surgery

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“…A validation set of 30 publications was created, including key studies known to the authors published since our previous search (July 29, 2014) . Using this set, the search strings used were validated; ie, each publication had to be identified before the search strings were used in this systematic review.…”

Section: Methodsmentioning

confidence: 99%

Effectiveness of offloading interventions to heal foot ulcers in persons with diabetes: a systematic review

Lazzarini

Jarl

Gooday

et al. 2020

Diabetes Metabolism Res

246

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Background Offloading interventions are commonly used in clinical practice to heal foot ulcers. The aim of this updated systematic review is to investigate the effectiveness of offloading interventions to heal diabetic foot ulcers. Methods We updated our previous systematic review search of PubMed, EMBASE, and Cochrane databases to also include original studies published between July 29, 2014 and August 13, 2018 relating to four offloading intervention categories in populations with diabetic foot ulcers: (a) offloading devices, (b) footwear, (c) other offloading techniques, and (d) surgical offloading techniques. Outcomes included ulcer healing, plantar pressure, ambulatory activity, adherence, adverse events, patient‐reported measures, and cost‐effectiveness. Included controlled studies were assessed for methodological quality and had key data extracted into evidence and risk of bias tables. Included non‐controlled studies were summarised on a narrative basis. Results We identified 41 studies from our updated search for a total of 165 included studies. Six included studies were meta‐analyses, 26 randomised controlled trials (RCTs), 13 other controlled studies, and 120 non‐controlled studies. Five meta‐analyses and 12 RCTs provided high‐quality evidence for non‐removable knee‐high offloading devices being more effective than removable offloading devices and therapeutic footwear for healing plantar forefoot and midfoot ulcers. Total contact casts (TCCs) and non‐removable knee‐high walkers were shown to be equally effective. Moderate‐quality evidence exists for removable knee‐high and ankle‐high offloading devices being equally effective in healing, but knee‐high devices have a larger effect on reducing plantar pressure and ambulatory activity. Low‐quality evidence exists for the use of felted foam and surgical offloading to promote healing of plantar forefoot and midfoot ulcers. Very limited evidence exists for the efficacy of any offloading intervention for healing plantar heel ulcers, non‐plantar ulcers, and neuropathic ulcers with infection or ischemia. Conclusion Strong evidence supports the use of non‐removable knee‐high offloading devices (either TCC or non‐removable walker) as the first‐choice offloading intervention for healing plantar neuropathic forefoot and midfoot ulcers. Removable offloading devices, either knee‐high or ankle‐high, are preferred as second choice over other offloading interventions. The evidence bases to support any other offloading intervention is still weak and more high‐quality controlled studies are needed in these areas.

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Evaluation of Hallux Interphalangeal Joint Arthroplasty Compared With Nonoperative Treatment of Recalcitrant Hallux Ulceration

Cited by 21 publications

References 7 publications

Surgical offloading procedures for diabetic foot ulcers compared to best non‐surgical treatment: a study protocol for a randomized controlled trial

Surgical offloading procedures for diabetic foot ulcers compared to best non‐surgical treatment: a study protocol for a randomized controlled trial

Comparison of Hallux Interphalangeal Joint Arthrodesis Fixation Techniques: A Retrospective Multicenter Study

Effectiveness of offloading interventions to heal foot ulcers in persons with diabetes: a systematic review

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