Massive Lymphatic Reaction to an Infected Silastic® Implant in a Diabetic Patient: a Case Report

Special Article- Diabetic Foot Care

Foot Ankle Stud. 2018; 2(2): 1015.

Massive Lymphatic Reaction to an Infected Silastic® Implant in a Diabetic Patient: a Case Report

Tyler J Beckley¹*, Anderson KC² and Manoli A³

¹Indiana University, School of Medicine, Indiana

²Indiana University, Beacon Orthopedic Surgery, Indiana

³Department of Orthopedic Surgery, Wayne State University School of Medicine, Michigan, USA

*Corresponding author: Tyler J Beckley DO, Clinical Assistant Professor, Indiana University, School of Medicine, 111N Ronald Reagan Parkway, Suite 148, Avon, Indiana

Received: September 14, 2018; Accepted: October 25, 2018; Published: November 01, 2018


A middle-aged man had a silicone Great toe implant with a protective grommet placed for a painful right bunion deformity with degenerative joint disease.

Ten years later he had developed adult onset insulin dependent diabetes mellitus and many other comorbidities. His right Great toe area had become very grossly swollen and painful. The medial surgical incision broke down and began draining.

At surgery a broken implant and grommet were removed. The soft tissues were immense and were minimally debulked. Tissue histology and cultures were performed.

A polymicrobal infection was present and many silicone wear particles were present in the microscopic sections.

Intravenous antibiotics were given which resulted in a painless, but grossly enlarged medial foot.

Keywords: Silicone implant; Silastic®; adult onset; Insulin dependent diabetes mellitus; wound infection; wear particles


Silicone joint implants were introduced in the early 1970’s by Albert Swanson, M.D. They have been used since that time in the orthopedic and podiatric communities for the management of joint deformity and arthritic conditions.

Initially, it was assumed that these implants were biocompatible, even when used in weight-bearing applications.

However, adverse effects such as synovitis, infection, bony necrosis, medullary and cortical destruction, and foreign body reactions often developed. Many of these negative processes were related to gross displacement of the implant and micro-particulate wear matter dispersion. The result of this can be lymphatic reticular transport of this silicone debris to local, and regional lymphatic tissues including lymph nodes and the surrounding tissues.

We present a case of massive lymphatic reaction to a silicone implant (Silastic®, Dow Corning, Midland, MI) in the first metatarsophalangeal joint (MTP), which was implanted ten years previously (Figure 1). Indications for the implanted prosthesis were hallux valgus with degenerative joint disease. The patient’s foot had massive lymphedema with fungating overgrowth of the affected foot and ankle soft tissues.