Six diabetic patients with a large, resistant ulcer on the plantar
surface of the great toe were treated by resection of the proximal one-half
of the proximal phalanx of the great toe through a dorsal median incision
followed by a split-thickness skin graft onto the ulcer bed. Each of these
ulcers had failed to heal with conservative measures which included
debridement, split-thickness skin grafts, and extra-depth shoes with molded
insoles. Preoperatively each patient had a complete vascular evaluation and
appropriate antibiotic treatment. Postoperatively the ulcers healed
promptly, and no ulcers had recurred at follow-up after two to five years.
The only complication was delayed healing of the incision in one patient.
At follow-up no obvious functional impairment of gait was evident, and each
patient had regained his or her original functional status.