Resection Arthroplasty, External Fixation, and Negative Pressure Dressing for First Metatarsophalangeal Joint Ulcers

BACKGROUND: A frequent complication for the diabetic patient is neuropathic ulceration on the plantar surface of the first metatarsophalangeal (MTP) joint which can be difficult to manage. Debridement and resection arthroplasty with temporary external fixation and VAC dressing (Kinetic Concepts Inc, San Antonio, TX) is an alternative operative treatment to amputation. This study examined the outcomes of one center's experience with patients who have undergone this procedure. MATERIALS AND METHODS: This retrospective cohort study examined patients who underwent the procedure between March 2002 and March 2010. Information was obtained on relevant outcomes including: the initial procedure, secondary procedures on either foot, total time in external fixation, time until amputation, cause of ulceration and co-morbid conditions. During the study period, 16 patients underwent resection arthroplasty with external fixation for first MTP ulceration. Fourteen of these patients had underlying diabetes mellitus, one had Charcot-Marie-Tooth disease and one had neuropathy of unknown cause. All were available for followup at the end of the study period. Median followup was 38 (range, 3 to 96) months. RESULTS: At latest followup, six patients required amputation, either transmetatarsal or transtibial, to treat their recurring ulceration. CONCLUSION: Resection arthroplasty with temporary external fixation appears to be a safe, effective and possible alternative to amputation for the treatment of neuropathic ulceration of the first MTP.