Clinical Efficacy of the First Metatarsophalangeal Joint Arthroplasty as a Curative Procedure for Hallux Interphalangeal Joint Wounds in Patients with Diabetes

David G Armstrong, Lawrence A. Lavery, Jefferey R. Vazquez, Brian Short, Heather R. Kimbriel, Brent P. Nixon, Andrew J M Boulton

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

OBJECTIVE - To evaluate the safety and efficacy of first metatarsophalangeal joint arthroplasty compared with standard, nonsurgical management of wounds at the plantar hallux interphalangeal joint in patients with diabetes. RESEARCH DESIGN AND METHODS - We evaluated 41 patients with ulcers classified as University of Texas Grade 1A or 2A at the plantar aspect of the first metatarsophalangeal joint using a case-control model. Case subjects were patients treated with resectional arthroplasty and control subjects received standard nonsurgical care. Both groups received standard off-loading and wound care. Outcomes included time to healing, reulceration, infection, and amputation. RESULTS - The surgery group healed significantly faster than patients in the standard therapy group (standard 67.1 ± 17.1 versus sugery 24.2 ± 9.9 days, P = 0.0001), and they had fewer recurrent ulcers (standard 35.0 versus surgery 4.8%, P = 0.02, odds ratio 7.6, 95% CI 1.1-261.7) Both groups had similar rates of infection (standard 38.1 versus surgery 40.0%, P = 0.9) and amputation (standard 10.0 versus surgery 4.8%, P = 0.5). CONCLUSIONS - Results suggest that resectional arthroplasty is a safe and effective procedure to treat wounds of the plantar hallux compared with nonsurgical therapy.

Original languageEnglish (US)
Pages (from-to)3284-3287
Number of pages4
JournalDiabetes Care
Volume26
Issue number12
DOIs
StatePublished - Dec 2003
Externally publishedYes

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Hallux
Metatarsophalangeal Joint
Arthroplasty
Joints
Wounds and Injuries
Amputation
Ulcer
Group Psychotherapy
Infection
Research Design
Odds Ratio
Safety

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Clinical Efficacy of the First Metatarsophalangeal Joint Arthroplasty as a Curative Procedure for Hallux Interphalangeal Joint Wounds in Patients with Diabetes. / Armstrong, David G; Lavery, Lawrence A.; Vazquez, Jefferey R.; Short, Brian; Kimbriel, Heather R.; Nixon, Brent P.; Boulton, Andrew J M.

In: Diabetes Care, Vol. 26, No. 12, 12.2003, p. 3284-3287.

Research output: Contribution to journalArticle

Armstrong, David G ; Lavery, Lawrence A. ; Vazquez, Jefferey R. ; Short, Brian ; Kimbriel, Heather R. ; Nixon, Brent P. ; Boulton, Andrew J M. / Clinical Efficacy of the First Metatarsophalangeal Joint Arthroplasty as a Curative Procedure for Hallux Interphalangeal Joint Wounds in Patients with Diabetes. In: Diabetes Care. 2003 ; Vol. 26, No. 12. pp. 3284-3287.
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abstract = "OBJECTIVE - To evaluate the safety and efficacy of first metatarsophalangeal joint arthroplasty compared with standard, nonsurgical management of wounds at the plantar hallux interphalangeal joint in patients with diabetes. RESEARCH DESIGN AND METHODS - We evaluated 41 patients with ulcers classified as University of Texas Grade 1A or 2A at the plantar aspect of the first metatarsophalangeal joint using a case-control model. Case subjects were patients treated with resectional arthroplasty and control subjects received standard nonsurgical care. Both groups received standard off-loading and wound care. Outcomes included time to healing, reulceration, infection, and amputation. RESULTS - The surgery group healed significantly faster than patients in the standard therapy group (standard 67.1 ± 17.1 versus sugery 24.2 ± 9.9 days, P = 0.0001), and they had fewer recurrent ulcers (standard 35.0 versus surgery 4.8{\%}, P = 0.02, odds ratio 7.6, 95{\%} CI 1.1-261.7) Both groups had similar rates of infection (standard 38.1 versus surgery 40.0{\%}, P = 0.9) and amputation (standard 10.0 versus surgery 4.8{\%}, P = 0.5). CONCLUSIONS - Results suggest that resectional arthroplasty is a safe and effective procedure to treat wounds of the plantar hallux compared with nonsurgical therapy.",
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