Novel Minimally Invasive Proximal Phalanx Osteotomy for Recurrent Plantar Diabetic Foot Ulcers of Hallux: A Case Series Describing a Novel Technique
Background: Diabetic foot ulcers (DFUs), especially recurrent plantar ulcers under the hallux, are a major clinical challenge. Minimally invasive techniques, such as proximal phalanx osteotomy, would offer promising outcomes in terms of ulcer healing and reduced recurrence. Objective: To evaluate th...
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| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
Jaypee Brothers Medical Publisher
2025-04-01
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| Series: | Journal of Foot and Ankle Surgery (Asia Pacific) |
| Subjects: | |
| Online Access: | https://www.jfasap.com/doi/JFASAP/pdf/10.5005/jp-journals-10040-1390 |
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| Summary: | Background: Diabetic foot ulcers (DFUs), especially recurrent plantar ulcers under the hallux, are a major clinical challenge. Minimally invasive techniques, such as proximal phalanx osteotomy, would offer promising outcomes in terms of ulcer healing and reduced recurrence.
Objective: To evaluate the efficacy of minimally invasive proximal phalanx osteotomy in diabetic patients with recurrent or nonhealing plantar ulcers under the interphalangeal joint of the hallux.
Methods: This retrospective case series included 20 patients with type 2 diabetes who underwent minimally invasive proximal phalanx osteotomy. Patients were evaluated for radiographic bone healing, ulcer healing, recurrence rates, functional outcomes [measured by the Foot and Ankle Disability Index (FADI)], and plantar pressure distribution using pedobarography.
Results: We operated on 20 unilateral cases (13 females, 7 males; mean age: 58.6 ± 7.1 years; diabetes duration: 11.3 ± 1.9 years). Radiological union occurred in 34.4 ± 2.1 days, with fibrous union in 15% of cases, though clinical stability and functional improvement were maintained. The average ulcer healing time was 17.05 ± 1.86 days, with complete healing in all patients and no recurrences during follow-up. Functional outcomes improved significantly, with FADI scores increasing from 47.3 ± 7.9 preoperatively to 81.6 ± 4.9 postoperatively (<i>p</i> < 0.001). Pedobarographic analysis revealed a postoperative reduction in plantar pressures under the great toe. Two patients experienced localized infections, which were managed successfully with antibiotics.
Conclusion: Minimally invasive proximal phalanx osteotomy is an effective and safe technique for treating recurrent plantar DFUs, significantly improving ulcer healing, functional outcomes, with a low recurrence and complication rate. |
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| ISSN: | 2348-280X 2394-7705 |