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.