SLR - June 2011 - Brandon Slade (2)
Reference: Johnson JE, Anderson SA. (2010). One Stage Resection and Pin Stabilization of First Metatarsophalangeal Joint for Chronic Plantar Ulcer With Osteomyelitis. Foot & Ankle International. Nov;31(11):973-9.
Scientific Literature Review
Reviewed by: Brandon Slade, DPM
Residency Program: DVA San Francisco
Podiatric Relevance:
Chronic plantar ulceration with osteomyelitis is routinely treated with extensive debridement of infected soft tissue and bone, and often results in first ray amputation. Hallux or first ray amputations have proven to be non-functional with reamputation rates reported as high as 60%. The authors in this study wanted to demonstrate if single stage resection with pin stabilization of the first MTPJ would be a successful alternative where there is salvage of the first ray to avoid its associated complications.
Methods:
This study was a retrospective review of 18 feet (15 patients) that underwent single staged first metatarsophalangel joint resection and pin stabilization by a single surgeon between 1998 and 2008. All patients had a diagnosis of diabetic peripheral neuropathy, chronic plantar first metatarsal head ulceration of at least 3 months with exposed bone, and no gross purulence or acute cellulitis. The average follow up was 48.8 months.
Results:
Only one of the 18 feet (5.6%) did not completely heal and resulted in transmetatarsal amputation. Of the remaining 17, six feet (35.3%) developed a recurrent ulceration with only three feet (17.6%) with recurrent ulcerations under the first metatarsal head. Seven feet (38.9%) were lost to follow up, deceased, or refused to participate in the study. Only one foot of those who were followed achieved bony union at the first MTPJ. All others achieved a stable fibrous union with little to no motion.
Conclusions:
The result of the study suggest that single-stage metatarsophalangeal joint resection with pin stabilization to create fusion or stiff fibrous union is a safe and effective alternative to first ray amputation in the setting of plantar first metatarsal head ulceration with underlying chronic osteomyelitis.