Conservative Surgery for Neuropathic Toe Ulcers with Exposed Bone or Joint in an Outpatient Setting: A Retrospective Study

Background: Toe ulcers complicated with osteomyelitis are frequently indicated for toe amputation possibly due to their having been implicated as a causative factor for partial foot amputations, and even of major limb amputations.

Methods: In a retrospective study on patients with toe ulcers with exposed bone or joint who underwent conservative surgery for toe salvage we identified patients with neuropathy and a single toe ulcer with exposed bone or joint. Patients had been operated on in an outpatient setting. After incision and exposure, aggressive debridement was performed using a small curette and rongeur. After stabilization, patients were sent home on antibiotics. Success was defined as complete healing with no recurrence 6 months after full wound closure and epithelization was achieved.

Results: Twenty five patients (72% male) had a total of 26 operations. Their mean age was 60 ±12. All patients had neuropathy, in 22 the neuropathy was related diabetes mellitus of 17±9 year`s duration. The mean ulcer age was 6 weeks (range 1 to 24). The mean number of visits per patient was 6.5 (range 3 to 20). The ulcers closed in a mean of 8 weeks (±6, range 3 to 24). At 6 months, 3 (11.5%) patients had needed a toe amputation for infection or necrosis that could not be controlled. None needed a major amputation or hospitalization related to the ulcer.

Conclusion: Saving toes with exposed bone or joint using conservative surgery is feasible and in a select population can have a high success rate (88%), even though it does demand more dedicated patient care.