Ipj and 1^ST MTPJ Fusion for Osteomyelitis and Septic Arthritis in Patients with Forefoot Diabetic Foot Ulcers

Background: Foot and ankle infections are among the most devastating and costly complications of diabetes mellitus.In cases of Diabetic Foot ulcers in the forefoot, acheving the erradication of the infection can be some times difficult . Since amputation is associated with functional impairment, the primary goal of treatment is to be as preserving as possible.we came up with a new treatment protocol for diabetic foot ulcers over the small bones of the forefoot.1.A thorough debridment of the infectious and necrotic tissue.2.Primary stabilization by fusing the joint.3.Sufficiant primary soft tissue coverage .

Materials and Methods: Retrospective Study.29 patients, 31 feet, with 12/31 (38%) IPJ septic arthritis and 19/31 (62%) 1st mtpj septic arthritis due to diabetic ulcers were treated between 2013-2016 .The primary end point of the study – Healed and closed forefoot diabetic ulcers. Secondary end points- Fusion rates both clinically and radipgraphically.

Results: In 27/31 cases (87%) the plantar diabetic ulcer was closed completly by one year post operativly. 12 months post op the number of radiographic fusions was 14/31 (45%) .Clinically, by one year post op 15/31 cases (48%) were stable on physical examination.

Conclusion: Arthrodesis of IP- and 1st MTP-joints in diabetic foot patients with a septic arthritis or osteomylitis have approved to be a successful way of treatment in order to achieve a stable situation for soft-tissue healing and wound closure. Trying to debride and stabilize the joint might reduce dramatically the number of toe or rays amputation, improve patient satisfaction and help maintain a good walking pattern.