Internal offloading of plantar lesions of the interphalangeal joint in diabetic foot syndrome-a case discussion

Diabetic Foot Ulcers in the area of the plantar interphalangeal joint (IPJ) of the first toe are usually caused by a restriction of the dorsal extension of the proximal phalanx in the roll movement. Due to reduced extension, the distal phalanx of the toe is extended in the course of propulsion and a pathological flexion of the IPJ occurs. The plantar skin in the region of the flexion skin fold is not designed to take the load, nor does it tolerate extension during the pathological load. There are many causes for restricted mobility of the metatarsophalangeal joint. Statistically, recurrences in the following year are frequent (> 50%) and local pressure relief in an orthopedic device is technically difficult, as it must combine principles of macro- and micro-offloading as well as immobilisation of the metatarsophalangeal joint. For this reason, surgical strategies for internal offloading should be considered at the latest at the first recurrence. Here, the Valenti procedure (dorsal open wedge resection of the metatarsal 1 head) will be compared with minimally invasive procedures.