Abstract
Biomechanically, the great toe with its metatarsophalangeal (MTP) joint plays a key role in standing and walking, making the first MTP joint one of the main predilection sites for ulcer formation, and consequently for bone and joint infection and even amputation. If conservative treatment fails, the main goal of surgery is to remove all infected tissue and preserve the first ray. To improve surgical outcomes, development of new biomaterials like Bioactive Glass S53P4 has begun. Bioactive Glass is useful because of its antibacterial properties; furthermore, its osteostimulative and osteoconductive qualities make the bone substitute particularly suitable as a bone defect filler for the treatment of osteomyelitis. The aim of our retrospective observational study was to compare the outcomes following ulcerectomy with segmental resection of the infected joint and bone and temporary stabilization with an external fixator, both with and without added Bioactive Glass. A comparison of added Bioactive Glass with the traditional surgical treatment in septic osteoarthritis of the first MTP joint showed Bioactive Glass to be effective. During a one-year follow-up, patients with Bioactive Glass required no additional antibiotic therapy or surgical intervention. Bioactive Glass, when applied to the diabetic foot, showed itself to be a safe bone substitute biomaterial.
Highlights
The great toe with its metatarsophalangeal (MTP) joint plays a key role in standing and walking
Up to 30% of people with diabetes will develop a foot ulcer, and every 20 s, an amputation of part of a limb or a whole limb is conducted globally due to diabetes [11]
Murdoch presented the importance of great toe preservation [5]. He reported a series of 71 patients who had undergone a disarticulation at the first MTP joint or who had needed an even more proximal amputation
Summary
The great toe with its metatarsophalangeal (MTP) joint plays a key role in standing and walking. Patients with diabetes and infected ulcers involving the MTP joint and periarticular bone of the great toe are very often difficult to treat, when they insist on being treated conservatively and refuse any surgical procedure. The standard protocol in these cases consists of extensive debridement of the infected soft tissues and resection of the infected bone [2] This approach, especially when a large area is affected, could make the great toe unstable, deformed, or even nonfunctional. The recurrence rate of osteomyelitis is high; in some cases, a relapse occurs after just a few months Based on these findings, it is understandable why patients after great toe or first ray amputation need another, higher reamputation. The aim of our retrospective study was to evaluate the possible advantages of segmental resection of the first MTP joint in combination with S53P4 BG compared to segmental resection without bone substitutes
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