Treatment of resistant ulcers on the plantar surface of the great toe in diabetics.

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.