The Journal of Bone and Joint Surgery, Vol 64, Issue 6 930-933, Copyright © 1982 by Journal of Bone and Joint Surgery, Inc
Treatment of resistant ulcers on the plantar surface of the great toe in diabetics
DM Downs and RL Jacobs
Six diabetic patients with a large, resistant ulcer on the plantar surface
of the great toe were treated by resection of the proximal one-half of the
proximal phalanx of the great toe through a dorsal median incision followed
by a split-thickness skin graft onto the ulcer bed. Each of these ulcers
had failed to heal with conservative measures which included debridement,
split-thickness skin grafts, and extra-depth shoes with molded insoles.
Preoperatively each patient had a complete vascular evaluation and
appropriate antibiotic treatment. Postoperatively the ulcers healed
promptly, and no ulcers had recurred at follow-up after two to five years.
The only complication was delayed healing of the incision in one patient.
At follow-up no obvious functional impairment of gait was evident, and each
patient had regained his or her original functional status.
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