Clinical Efficacy of the First Metatarsophalangeal Joint Arthroplasty as a Curative Procedure for Hallux Interphalangeal Joint Wounds in Patients with Diabetes

  1. David G. Armstrong, DPM, MSC1,
  2. Lawrence A. Lavery, DPM, MPH2,
  3. Jefferey R. Vazquez, DPM1,
  4. Brian Short, DPM1,
  5. Heather R. Kimbriel, BA1,
  6. Brent P. Nixon, DPM, MBA1 and
  7. Andrew J.M. Boulton, MD34
  1. 1Department of Surgery, Podiatry Section, Southern Arizona Veterans Affairs Medical Center, Tucson, Arizona
  2. 2Department of Surgery, Texas A&M Health Science Center, Scott and White Hospital, Temple, Texas
  3. 3Diabetes Research Institute, University of Miami, Miami, Florida
  4. 4Department of Medicine, Manchester Royal Infirmary, Manchester, U.K
  1. Address correspondence and reprint requests to Dr. David Armstrong. Southern Arizona Veterans Affairs Medical Center, Department of Surgery, Podiatry Section, 3601 South Sixth Ave., Tucson, AZ. E-mail: armstrong{at}usa.net

Abstract

OBJECTIVE—To evaluate the safety and efficacy of first metatarsophalangeal joint arthroplasty compared with standard, nonsurgical management of wounds at the plantar hallux interphalangeal joint in patients with diabetes.

RESEARCH DESIGN AND METHODS—We evaluated 41 patients with ulcers classified as University of Texas Grade 1A or 2A at the plantar aspect of the first metatarsophalangeal joint using a case-control model. Case subjects were patients treated with resectional arthroplasty and control subjects received standard nonsurgical care. Both groups received standard off-loading and wound care. Outcomes included time to healing, reulceration, infection, and amputation.

RESULTS—The surgery group healed significantly faster than patients in the standard therapy group (standard 67.1 ± 17.1 versus sugery 24.2 ± 9.9 days, P = 0.0001), and they had fewer recurrent ulcers (standard 35.0 versus surgery 4.8%, P = 0.02, odds ratio 7.6, 95% CI 1.1–261.7) Both groups had similar rates of infection (standard 38.1 versus surgery 40.0%, P = 0.9) and amputation (standard 10.0 versus surgery 4.8%, P = 0.5).

CONCLUSIONS—Results suggest that resectional arthroplasty is a safe and effective procedure to treat wounds of the plantar hallux compared with nonsurgical therapy.

Footnotes

  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted September 7, 2003.
    • Received July 21, 2003.
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  1. doi: 10.2337/diacare.26.12.3284 Diabetes Care December 2003 vol. 26 no. 12 3284-3287
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