Proximal Derotation Phalangeal Osteotomy for Medial First Toe Diabetic Ulcer

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.