Fig. 7: A case of reulceration following first ray amputation (1 RA).
From: Preserving the first ray or first two rays in forefoot amputation for diabetic foot ulcers
a A 56-year-old female patient had first ray necrosis due to a severe diabetic foot ulcer (DFU). b The patient underwent the 1 RA. c Two months postoperatively, a reulceration occurred at the forefoot. d The recalcitrant ulcer lasted for 1 year despite the use of orthotics and treatments such as wound care and dressing changes. e The transferring load also led to dislocation of the second metatarsophalangeal joint (red arrow), the development of a claw toe in the third ray, and biomechanical disturbances of the foot. f The patient subsequently underwent further surgery to excise the ulcer and correct the forefoot biomechanics (excisional arthroplasty for the second metatarsophalangeal joint; Weil’s osteotomy for the third and fourth metatarsals).
