Medially Based Hallux Interphalangeal Joint Arthroplasty in the Management of Hallux Ulceration: Surgical Technique and Result in Six Consecutive Cases

Abstract

Introduction. Plantar hallux wounds are common in patients with diabetic neuropathy. Several techniques, both surgical and nonsurgical, are designed to offload plantar wounds. However, controversy exists regarding which techniques are superior in terms of efficacy, safety, and longevity. Objective. This manuscript presents a simple, minimally invasive technique to permanently offload the plantar IPJ of the hallux in the case of recalcitrant plantar ulcerations. The authors describe their surgical technique for and outcomes of medially based hallux IPJ arthroplasty for the management of recalcitrant hallux ulcerations. Materials and Methods. Five patients (6 wound cases) were evaluated. All patients underwent the same surgical procedure and were subject to the same postoperative protocol of full weight-bearing as tolerated. Results. All 5 cases healed, with an average time to healing of 15.5 days (range, 10–22 days) and no instances of recurrence. The average time to final follow-up was 83.17 weeks (range, 54–95 weeks). Conclusions. The medially based hallux IPJ arthroplasty approach has demonstrated ability to adequately offload hallux ulcerations, permits bone biopsy or resection for treatment of underlying bone infection, and allows for immediate weight-bearing.

Interphalangeal Resection Arthroplasty for the Prevention and Treatment of Diabetic Deformities and Ulcers of the Toes: A Systematic Review and Meta-analysis

“…In total, 6 studies were retained for the meta-analysis. 2 , 4 , 7 , 8 , 16 , 19 Figure 1 shows the PRISMA flowchart.…”

“…Three studies 4 , 8 , 16 were limited to ulcers located in the hallux, 2 studies 2 , 7 to the lateral (lesser) toes, and another one 19 to all toes. The mean age of the pooled sample was 59.7 ± 5 years.…”

“…Five studies 2 , 4 , 7 , 8 , 16 reported the healing rate with a pooled frequency of 93.6% (0.889 to 0.970, I 2 = 11.6%). Armstrong et al 2 demonstrated no difference in healing between patients having a toe deformity with previous ulcer history compared with those without.…”

“…Four studies reported on time to ulcer healing, 4 , 7 , 8 , 19 with a mean pooled period of 4.3 ± 1.8 weeks. Lew et al 8 reported the comparative results between IP-RA and standard care, with a significantly longer time for the latter ( P = .03).…”

“…Four studies 2 , 4 , 7 , 8 reported on postoperative infection with a weighted frequency of 10.5% (95% CI = 0.038 to 0.198, I 2 = 40%). Armstrong et al 2 reported that patients with a history of previous ulceration were significantly more likely to suffer a postoperative infection ( P = .04).…”