Total contact casting and Keller arthoplasty for diabetic great toe ulceration under the interphalangeal joint

Interphalangeal (IP) ulcerations of the great toe are frequently encountere d in neuropathic diabetic feet. While total contact casting is usually effe ctive as a first line treatment, recalcitrant ulcers continue to present su bstantial management challenges. The authors retrospectively reviewed the r esults of Keller arthroplasty employed to accelerate ulcer resolution with total contact casting in fourteen patients with neuropathic ulcers under th e great toe interphalangeal (IP) joint that were resistant to casting alone . These data were compared to a group of similar patients whose ulcers were successfully treated by non-operative measures. No operative complications were observed, and all ulcers healed within twenty-four days with no recur rence documented at an average follow-up of 26 weeks. In cases of resistant great toe IP plantar ulcers associated with hallux rigidus that have faile d casting trials, this treatment method can be effective.