case_images: PMC11818724_01
case_images: Preoperative and postoperative foot photographs and plantar pressure values. (a) Preoperative ulcers on the dorsal PIP joint and plantar MTP joint of the third toe, highlighting significantly elevated plantar pressure (6.61 kPa/cm2) (red circle). (b) Postoperative healing and pressure reduction to 3.54 kPa/cm2 (red circle).
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case_images: PMC11818724_01_jcm-14-00646-g001.jpg
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case_images: PIP joint and on the plantar aspect of the third metatarsal head can be classified as W1I2fI2 (Stage 4) and W2I2fI2 (Stage 4), respectively. Plantar pressure mapping revealed high-pressure areas at the third toe's MTP joint (6.61 kPa/cm2) (Figure 1a). The plantar pressure at the MTP joint decreased to 3.54 kPa/cm2 (Figure 1b).
case_images: Revascularization. (a) Preoperative stenosis in the anterior tibial artery (outlined triangle) and dorsal foot artery (black-filled triangle). (b) Selective angiography of preoperative stenosis in the dorsal foot artery. (c) The lateral plantar artery was dilated using a 2 mm x 220 mm PTA balloon. (d,e) Postoperative angiographic findings: restored blood flow from the dorsal foot artery and the lateral plantar artery to the plantar metatarsal artery ((1)) and the plantar digital artery ((2)) of the third toe is visible.
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case_images: PMC11818724_01_jcm-14-00646-g002b.jpg
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case_images: Angiography revealed 75% stenosis in the anterior tibial artery, 90% stenosis in the dorsal foot artery, and occlusion in the posterior tibial artery's distal branches (Figure 2a,b). PTA was performed using PTA balloons of varying sizes (Figure 2c), achieving restored in-line flow to the third toe's plantar arteries (Figure 2d,e).
case_images: Surgical procedures. (Upper left) PIP resection arthroplasty showing incision ((1)) and resection steps ((2)). (Upper right) metatarsal shortening osteotomy. A 45 oblique osteotomy was performed at the distal third of the metatarsal ((3)). (Lower figure) the third metatarsal head was shortened by sliding it proximally ((4)), and internal fixation with a K-wire ensured stabilization ((5)).
case_images: jcm-14-00646-g003.jpg
case_images: PMC11818724_01_jcm-14-00646-g003.jpg
case_images: jcm-14-00646-f003
case_images: The PIP joint was accessed dorsally, infected tissues were excised, and the head of the proximal phalanx was resected (Figure 3 (upper left)). A 45 oblique osteotomy was performed at the distal third of the metatarsal (Figure 3 (upper right)). The third metatarsal head was shortened by sliding it proximally, and internal fixation with a K-wire ensured stabilization (Figure 3 (lower figure)).