A small case series of toe sparing surgery: excision of the first metatarsophalangeal joint in diabetic patients to facilitate wound healing

AbstractAim: Various surgical options exist for failed antibiotic treatment of non-healing ulcer or osteomyelitis of the first metatarsophalangeal (MTP) joint. Our aim was to look at the outcome of patients undergoing toe-sparing surgery during excision of the first MTP.Methods: A prospective series of patients undergoing toe-sparing surgery of the first MTP joint under one vascular surgeon from 2014 to 2016 and looked after by the multidisciplinary diabetic foot team was studied. All patients undergoing surgery were followed up until wound healing. Complications and time to healing were recorded including any subsequent procedures.Results: Seven men (mean age 56.4 years) with diabetes underwent this procedure. Mean wound healing time was 9.5 weeks (range 5–16 weeks). All toes were preserved with no new ulcerations and minimal complications.Conclusion: In selected patients with first MTP joint ulceration and/or osteomyelitis, toe-sparing surgery can be undertaken with excellent results, preserving the toe with fast wound healing and no ischaemia to the adjacent toe.