• 1

    Fleischli JE, Anderson RB, Davis WH: Dorsiflexion metatarsal osteotomy for treatment of recalcitrant diabetic neuropathic ulcers. .Foot Ankle Int 20::80. ,1999. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Hong TF, Brodsky JW: Surgical treatment of neuropathic ulcerations under the first metatarsal head. .Foot Ankle Clin 2::57. ,1997. .

  • 3

    Giurini JM, Chrzan JS, Gibbons GW, et al: Sesamoidectomy for the treatment of chronic neuropathic ulcerations. .JAPMA 81::167. ,1991. .

  • 4

    Ris HB, Reber P: Preservation of the first ray in a diabetic patient with a penetrating ulcer and arterial insufficiency by use of debridement and external fixation. .Eur J Vasc Surg 8::514. ,1994. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Blume PA, Paragas LK, Sumpio BE, et al: Single-stage surgical treatment of noninfected diabetic foot ulcers. .Plast Reconstr Surg 109::601. ,2002. .

  • 6

    Cooper PS: Orthopedic considerations in wound healing of the lower extremity. .Foot Ankle Clin 6::715. ,2001. .

  • 7

    Bowker JH: Partial foot amputations and disarticulations. .Foot Ankle Clin 2::153. ,1997. .

  • 8

    Smith DG: Principles of partial foot amputations in the diabetic. .Foot Ankle Clin 2::171. ,1997. .

  • 9

    Pulla RJ, Kaminsky KM: Toe amputations and ray resections. .Foot Ankle Clin 14::691. ,1997. .

  • 10

    Murdoch DP, Armstrong DG, Dacus JB, et al: The natural history of great toe amputations. .J Foot Ankle Surg 36::204. ,1997. .

  • 11

    Myerson MS, Miller SD, Henderson MR, et al: Staged arthrodesis for salvage of the septic hallux metatarsophalangeal joint. .Clin Orthop Rel Res 307::174. ,1994. .

    • Search Google Scholar
    • Export Citation
  • 12

    Buchholz H, Engelbrecht H: Uber die depotwirkung eineger antibiotica bei vermischung mit dem kunstharz palaces. .Chirurg 41::511. ,1970. .

  • 13

    Roeder B, van Gils CC, Maling S: Antibiotic beads in the treatment of diabetic pedal osteomyelitis. .J Foot Ankle Surg 39::124. ,2000. .

  • 14

    Myerson MS, Schon LC, McGuigan FX, et al: Result of arthrodesis of the hallux metatarsophalangeal joint using bone graft for restoration of length. .Foot Ankle Int 21::297. ,2000. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Coughlin MJ, Mann RA: Arthrodesis of the first metatarsophalangeal joint as salvage for the failed Keller procedure. .J Bone Joint Surg Am 69::68. ,1987. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Brodsky JW, Ptaszek AJ, Morris SG: Salvage first MTP arthrodesis utilizing ICBG: clinical evaluation and outcome. .Foot Ankle Int 21::290. ,2000. .

  • 17

    Rochwerger A, Lecoq C, Curvale G, et al: Salvage arthrodesis of the first metatarsophalangeal joint using bone grafts. .Rev Chir Orthop Reparatrice Appar Mot 88::501. ,2002. .

    • PubMed
    • Search Google Scholar
    • Export Citation

Salvage of the First Ray in a Diabetic Patient with Osteomyelitis

View More View Less
  • 1 Weil Foot and Ankle Institute, Des Plaines, IL.
Restricted access

A case report is presented of a 65-year-old diabetic woman with an 18-month history of a penetrating ulcer of the plantar aspect of the first metatarsal head with associated sepsis of the first metatarsophalangeal joint and adjacent underlying osteomyelitis. Salvage of the first metatarsophalangeal joint was performed through aggressive soft-tissue and osseous debridement, external fixation with antibiotic-loaded polymethyl methacrylate bone cement, and delayed interpositional autogenous iliac crest bone graft arthrodesis. Osseous incorporation of the interposed bone graft occurred 12 weeks postoperatively. No soft-tissue or osseous complications occurred during the postoperative period, and at 1-year follow-up there was no evidence of ulceration recurrence, transfer ulceration, shoe-fit problems, or gait abnormalities. A detailed review of the literature on the use of external fixation and interpositional bone graft distraction arthrodesis of the first metatarsophalangeal joint is presented. (J Am Podiatr Med Assoc 94(5): 492–498, 2004)

Corresponding author: Thomas S. Roukis, DPM, Weil Foot and Ankle Institute, 1455 E Golf Rd, Ste 131, Des Plaines, IL 60016.