Selective Plantar Fascia Release for Hallux Interphalangeal Joint Ulcerations

Dr. Fahad Hussain shares background and insights from his case series, “Clinical Outcomes of Selective Plantar Fascia Release for Hallux Interphalangeal Joint Ulcerations.” Read the full paper here.

Transcript

Fahad Hussain, DPM:

Hi. I'm Dr. Fahad Hussain. I'm a 3^rd-year foot and ankle surgery resident at Community Medical Center in Toms River, New Jersey. I've attended the University of Houston for my undergraduate studies and then went on to attend Temple University School of Podiatric Medicine in Philadelphia, Pennsylvania. Over the years, I've developed a special interest in reconstructive surgery, trauma surgery, limb salvage, and minimally invasive surgery. Throughout my training, I've been able to attend many workshops and conferences throughout the country to gain specialized skills in arthroscopy, minimally invasive surgery, lower extremity flaps, and external fixators. I've also been involved in and been a part of medical research as well.

As physicians, we know that ulcers can lead to amputations. Previous studies have shown that the 5-year mortality rate after a first-time ulcer is about 40% in diabetics, and this even increases with patients with major limb amputations. Ulcers and amputations are not only detrimental to the patients, but they have a huge economic consequence as well to the patients, hospitals, countries, and society. Thus, it's very important to prevent these ulcers and for treatment of these ulcers.

Ulcers at the plantar and planar medial aspect of the hallux interphalangeal joint are quite common and often they're very hard to treat. They can come from many different causes, including neuropathic, structural, and biomechanical causes. While there's different treatment modalities and procedures for these type of ulcers, we selected the plantar fascia release. This procedure involves transecting of selected fibers of the plantar fascia in order to help reduce pressure and eventually lead to healing of forefoot ulcers. We selected this procedure specifically for hallux interphalangeal joint ulcers.

Plantar hallux ulcers, hallux amputations, and first-rate amputations are very common in our area of practice. We noticed that these ulcers and amputations often lead to more proximal amputations. Thus, we came across and researched the selective plantar fascia release procedure. We then implemented it in our own practice, and we found that the procedure was easy to perform. The procedure did not necessitate prolonged periods of immobilization, and the procedure could be performed in the office setting and in the operating room setting.

What was surprising in our study was the rate of healing of the plantar hallux interphalangeal joint ulcers and the time of healing after we performed the procedure.

Foot ulcers are a challenge to both the patients and to the providers. We do believe that hallux interphalangeal joint ulcers could be treated with selective plantar fascial release if the patient and the provider are aware of the potential complications and the potential limitations of this procedure. We do think that further study should be done to evaluate the efficiency and the reproducibility of our results. We also believe that a comparative study should be done between patients with hallux interphalangeal joint ulcers treated with the selective plantar fascia release procedure versus patients treated with other surgical modalities.