Salvage of the neuropathic foot by using bone resection and tendon balancing: A retrospective review of 10 patients

Tibialis Anterior Tendon Lengthening: Adjunctive Treatment of Plantar Lateral Column Diabetic Foot Ulcers

“…Adjunctive treatment of diabetic ulcerations by lengthening, rerouting, or transecting tendons in the lower extremity has been previously described (9)(10)(11)(12)(13)(14). Specifically, lengthening of the tibialis anterior tendon has been successfully used for surgical treatment of clubfoot (15).…”

Surgical off-loading of the diabetic foot

“…48 Various metatarsal procedures have been de- scribed, including metatarsal head osteotomies and resections. 38,49,50 An isolated metatarsal osteotomy should be considered for a chronic, nonundermining, nontunneling, ulcer below a specific metatarsal head.…”

“…52 Hamilton et al 48 proposed combining lesser metatarsal head resections with gastrocnemius recession and a peroneus longus-to-brevis tendon transfer in patients with chronic, neuropathic forefoot ulcerations. All ulcers were located beneath lesser metatarsal heads, allowing the authors to preserve the first MTPJ.…”

“…The authors reported ulcer healing in 10 patients (100%), with no ulcer recurrence at a mean 14.2 months of follow-up. 48 …”

Chronic diabetic ulcers under the first metatarsal head treated by staged tendon balancing: A prospective cohort study

“…8 Two retrospective studies have reported encouraging results of tendon lengthening, either alone or in combination with bone resection for chronic neuropathic plantar forefoot ulceration. 9,10 Ulceration over the prominent first metatarsal head is a frequent problem. [11][12][13][14] Increased pressure under the first metatarsal head is thought to result from an imbalance of the three extrinsic muscles to the first ray, extensor hallucis longus (EHL), flexor hallucis longus (FHL) and peroneus longus and intrinsic muscle weakness.…”