From the Guidelines
Hallux interphalangeal joint resection is not a recommended procedure for the treatment of foot ulcers in persons with diabetes, according to the most recent guidelines 1.
Key Considerations
- The guidelines recommend Achilles tendon lengthening or metatarsal head resection in combination with an offloading device for the treatment of neuropathic plantar ulcers, but do not mention hallux interphalangeal joint resection as a recommended procedure 1.
- The procedure may be considered for patients with severe arthritis, deformity, or chronic pain in the interphalangeal joint of the big toe that hasn't responded to conservative treatments, but this is not specifically addressed in the guidelines 1.
- The guidelines do discuss joint arthroplasty as a possible treatment option for hallux ulcers with limited range of motion of the first metatarsal-phalangeal joint, but this is a different procedure than hallux interphalangeal joint resection 1.
Potential Risks and Benefits
- The guidelines highlight the importance of considering the potential risks and benefits of any surgical procedure, including the risk of infection, new lesions, and decreased quality of life during healing 1.
- The guidelines also emphasize the need for careful patient selection and consideration of individual patient factors, such as the presence of osteomyelitis or joint infection, when deciding on a treatment plan 1.
Treatment Alternatives
- The guidelines recommend a conditional approach to the treatment of foot ulcers, with a focus on non-surgical offloading interventions as the first line of treatment 1.
- Surgical procedures, such as Achilles tendon lengthening or metatarsal head resection, may be considered if non-surgical interventions have failed, but hallux interphalangeal joint resection is not a recommended procedure 1.
From the Research
Hallux Interphalangeal Joint Resection
- Hallux interphalangeal joint resection is a surgical procedure that may be considered for various pathologies, including hallux valgus, hallux limitus/rigidus, and gout 2
- The procedure involves the removal of the interphalangeal joint, which can be performed using different techniques, such as arthrodesis or resection arthroplasty
- The goal of the procedure is to alleviate pain and improve function in the affected toe
Indications for Hallux Interphalangeal Joint Resection
- Hallux interphalangeal joint resection may be indicated for patients with severe hallux valgus or hallux limitus/rigidus who have not responded to conservative treatment 3
- The procedure may also be considered for patients with rheumatoid arthritis who have developed interphalangeal hyperextension deformity 3
- Other indications for hallux interphalangeal joint resection include painful callosity on the plantar hallux and limited dorsiflexion at the metatarsophalangeal joint 3
Techniques for Hallux Interphalangeal Joint Resection
- Different techniques have been proposed for hallux interphalangeal joint arthrodesis, including "V"-shaped osteotomy combined with internal fixation 4
- Other fixation techniques, such as single screw fixation, multiple screws, and screw plus other fixation, have also been used 5, 6
- The choice of technique may depend on the individual patient's anatomy and the surgeon's preference
Complications of Hallux Interphalangeal Joint Resection
- Hallux interphalangeal joint resection is associated with a risk of complications, including nonunion, infection, and reoperation 5, 6
- The nonunion rate for hallux interphalangeal joint arthrodesis has been reported to be as high as 25.5% 5
- Patients with diabetes may be at higher risk for nonunion and other complications 5