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Proximal Derotation Phalangeal Osteotomy for Medial First Toe Diabetic Ulcer

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Abstract

Background

Foot ulcers are a common complication in diabetic patients. Mild callus formation due to a plantar pressure can lead to an ulcer formation with potentially hazardous sequelae. Eliminating the pressure from the ulcer is essential for a proper healing process. Proximal derotation phalangeal osteotomy is a relatively simple procedure that can redistribute the planter pressure points over the hallux.

Methods

Thirteen patients underwent proximal derotation phalangeal osteotomy to relieve the bony pressure causing an ulcer in the first toe, which was refractory to non-operative treatment. Twelve patients had diabetes type 2 and one had Charcot-Marie-Tooth disease.

Results

Ulcers were completely resolved in all 13 patients in an average time of 4.3 (range 2–8) weeks. Four patients (31%) had mild complications that resolved well. No further surgery was required at 1-year follow-up.

Conclusion

Proximal derotation phalangeal osteotomy enabled ulcer healing in refractory cases.

Level of Evidence

Level III retrospective study.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Author notes

  1. Ezequiel Palmanovich, Nissim Ohana, David Segal and Ran Atzmon had equal contributions to this work.

Authors and Affiliations

  1. Orthopedic Department, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel

    Ezequiel Palmanovich, Nissim Ohana, Omer Slevin & David Segal

  2. Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Ezequiel Palmanovich, Nissim Ohana, Omer Slevin, Eran Tamir, Small Ilan & David Segal

  3. Department of Orthopaedic Surgery, Assaf HaRofeh Medical Center, Zerifin, Israel

    Eran Tamir

  4. Department of Orthopedic Surgery, Assuta Medical Center, Ashdod, Israel

    Ran Atzmon

  5. Affiliated with the Faculty of Health and Science, Ben Gurion University of the Negev, Beer-Sheva, Israel

    Ran Atzmon

Authors
  1. Ezequiel Palmanovich
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  2. Nissim Ohana
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  3. Omer Slevin
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  5. Small Ilan
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Correspondence to Ezequiel Palmanovich.

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The study was performed in human and approved by local IRB.

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Palmanovich, E., Ohana, N., Slevin, O. et al. Proximal Derotation Phalangeal Osteotomy for Medial First Toe Diabetic Ulcer. JOIO 55 (Suppl 1), 97–102 (2021). https://doi.org/10.1007/s43465-020-00193-5

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  • DOI: https://doi.org/10.1007/s43465-020-00193-5

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