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

Alok Tiwari, Ian Wilson, Marianne DeBrito, Miruna David, Mujahid A Saeed



Aim: 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.


toe, infection, osteomyelitis, surgery, diabetes mellitus, foot disease

Full Text:



Kerr M. NHS. Footcare for people with diabetes: the economic case for change. https://diabetes-resources-production.s3-eu-west-1.amazonaws.com/diabetes-storage/2017-08/Factsheet%20Footcare.pdf

Rice JB, Desai U, Cummings AK, Birnbaum HG, Skornicki M, Parsons NB. Burden of diabetic foot ulcers for Medicare and private insurers. Diabetes Care 2014;37:651–8. https://doi.org/10.2337/dc13-2176

NHS. National Diabetes Foot Care Audit, Third Annual Report, England and Wales, 14 July 2015 to 31 March 2017, V1.0. 14 March 2018. https://www.hqip.org.uk/wp-content/uploads/2018/03/National-Diabetes-Foot-Care-Audit-2014-2017.pdf (accessed 26 April 2018).

Murdoch DP, Armstrong DG, Dacus JB, Laughlin TJ, Morgan CB, Lavery LA. The natural history of great toe amputations. J Foot Ankle Surg 1997;36:204–8. https://doi.org/10.1016/S1067-2516(97)80116-0

Chisman R, Lowry D, Saeed MA, Tiwari A, David MD. Prescribing antibiotics in diabetic foot infection: what is the role of initial microscopy and culture of tissue samples? Int Wound J 2017;14:685–90. https://doi.org/10.1111/iwj.12674

Hingorani A, LaMuraglia GM, Henke P, et al. The management of diabetic foot: a clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine. J Vasc Surg 2016;63(2 Suppl):3S–21S. https://doi.org/10.1016/j.jvs.2015.10.003

Jogia RM, Modha DE, Nisal K, Berrington R, Kong M-F. Use of highly purified synthetic calcium sulfate impregnated with antibiotics for the management of diabetic foot ulcers complicated by osteomyelitis. Diabetes Care 2015;38:e79–80. https://doi.org/10.2337/dc14-3100.

Nehler MR, Whitehill TA, Bowers SP, et al. Intermediate-term outcome of primary digit amputations in patients with diabetes mellitus who have forefoot sepsis requiring hospitalization and presumed adequate circulatory status. J Vasc Surg 1999;30:509–17. https://doi.org/10.1016/S0741-5214(99)70078-9

Shaikh N, Vaughan P, Varty K, Coll AP, Robinson AH. Outcome of limited forefoot amputation with primary closure in patients with diabetes. Bone Joint J 2013;95-B:1083–7. https://doi.org/10.1302/0301-620X.95B8.31280

Dalla Paola L, Carone A, Morisi C, Cardillo S, Pattavina M. Conservative surgical treatment of infected ulceration of the first metatarsophalangeal joint with osteomyelitis in diabetic patients. J Foot Ankle Surg 2015;54:536–40. https://doi.org/10.1053/j.jfas.2014.08.004

Lavery LA, Lavery DC, Quebedeax-Farnham TL. Increased foot pressures after great toe amputation in diabetes. Diabetes Care 1995;18:1460–2. https://doi.org/10.2337/diacare.18.11.1460

DOI: https://doi.org/10.15277/bjd.2018.181


  • There are currently no refbacks.

The Journal of the Association of British Clinical Diabetologists