Proximal Derotation Phalangeal Osteotomy for Medial First Toe Diabetic Ulcer

Ezequiel Palmanovich*, Nissim Ohana, Omer Slevin, Eran Tamir, Small Ilan, David Segal, Ran Atzmon

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


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.

Original languageEnglish
Pages (from-to)97-102
Number of pages6
JournalIndian Journal of Orthopaedics
StatePublished - May 2021


  • Derotation osteotomy
  • Diabetes mellitus
  • Diabetic foot
  • Hallux
  • Ulcer


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