*Podiatric Medicine and Surgery Residency Program, Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC.
†Lower Extremity Limb Salvage/Trauma, University of Pittsburgh Medical Center, Pittsburgh, PA.
J Am Podiatr Med Assoc. 2022 Apr 27;112(2):20-104. doi: 10.7547/20-104.
Recurrent ulceration is a common problem after partial first-ray amputations. Loss of the first metatarsophalangeal joint contributes to altered biomechanics and increased pressure on the foot. This may increase risk of adjacent ulcerations and additional amputations. Preserving first-ray length maintains the metatarsal parabola and limits transfer lesions, but few data support this. We aimed to evaluate the incidence of ulceration after partial first-ray amputations and to assess the association between metatarsal protrusion distance and recurrent ulceration.
Thirty-two consecutive patients underwent unilateral partial first-ray amputation at various levels along the first metatarsal, and the metatarsal protrusion distance was measured after surgery. Incidence of ulceration was evaluated on the ipsilateral foot. We hypothesized that patients with a longer first metatarsal were less likely to ulcerate again on the ipsilateral foot.
Fourteen patients (43.8%) ulcerated again after partial first-ray amputation. Mean time to ulceration was 104 days. Active smoking status was associated with increased risk of another ulceration (P = .02), and chronic kidney disease was associated with a decreased risk of recurrent ulceration (P = .03). The average metatarsal protrusion distance for patients who ulcerated again after surgery was 36.1 mm versus 25.9 mm for patients who did not (P = .04). Logistic regression analysis of the receiver operating characteristic curve demonstrated an ideal cutoff length for recurrent ulceration of 37 mm (area under the curve = 0.7381). Patients with a protrusion distance greater than 37 mm were nine times as likely to ulcerate again (95% CI, 1.7-47.0).
Partial first-ray amputations can be a good initial salvage procedure to clear infection and prolong bipedal ambulatory status. Unfortunately, these patients are prone to recurrent ulceration. Significant loss of first metatarsal length is a poor prognostic indicator for recurrent ulceration.
部分第一跖骨截肢后，溃疡复发是一个常见问题。第一跖趾关节丧失会导致生物力学改变和足部压力增加。这可能会增加相邻溃疡和进一步截肢的风险。保留第一跖骨长度可以维持跖骨抛物线并限制转移病变，但很少有数据支持这一点。我们旨在评估部分第一跖骨截肢后溃疡的发生率，并评估跖骨突出距离与溃疡复发之间的关系。
32 例连续患者在第一跖骨的不同水平行单侧部分第一跖骨截肢，并在手术后测量跖骨突出距离。评估同侧足部溃疡的发生率。我们假设第一跖骨较长的患者在同侧足部再次发生溃疡的可能性较小。
14 例患者（43.8%）在部分第一跖骨截肢后再次发生溃疡。溃疡的平均时间为 104 天。吸烟状态与再次发生溃疡的风险增加相关（P=0.02），慢性肾脏病与溃疡复发风险降低相关（P=0.03）。手术后再次发生溃疡的患者的平均跖骨突出距离为 36.1mm，而未发生溃疡的患者为 25.9mm（P=0.04）。接受者操作特征曲线的逻辑回归分析显示，复发溃疡的理想截距长度为 37mm（曲线下面积为 0.7381）。跖骨突出距离大于 37mm 的患者再次发生溃疡的可能性增加九倍（95%CI，1.7-47.0）。
部分第一跖骨截肢术是清除感染和延长双足步行状态的良好初始挽救手术。不幸的是，这些患者容易发生溃疡复发。第一跖骨长度明显丧失是溃疡复发的不良预后指标。
