en
Scientific article
English

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

Published inJournal of bone and joint surgery. British volume, vol. 91, no. 4, p. 487-493
Publication date2009
Abstract

We studied a cohort of 26 diabetic patients with chronic ulceration under the first metatarsal head treated by a modified Jones extensor hallucis longus and a flexor hallucis longus transfer. If the first metatarsal was still plantar flexed following these two transfers, a peroneus longus to the peroneus brevis tendon transfer was also performed. Finally, if ankle dorsiflexion was < 5 degrees with the knee extended, a Strayer-type gastrocnemius recession was performed. The mean duration of chronic ulceration despite a minimum of six months' conservative care was 16.2 months (6 to 31). A total of 23 of the 26 patients were available for follow-up at a mean of 39.6 months (12 to 61) after surgery. All except one achieved complete ulcer healing at a mean of 4.4 weeks (2 to 8) after surgery, and there was no recurrence of ulceration under the first metatarsal. We believe that tendon balancing using modified Jones extensor hallucis longus and flexor hallucis longus transfers, associated in selected cases with a peroneus longus to brevis transfer and/or Strayer procedure, can promote rapid and sustained healing of chronic diabetic ulcers under the first metatarsal head.

Keywords
  • Adult
  • Aged
  • Ankle Joint/physiopathology
  • Chronic Disease
  • Diabetic Foot/pathology/physiopathology/*surgery
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Range of Motion, Articular
  • Tendon Transfer/*methods
  • Tendons/*surgery
  • Treatment Outcome
Citation (ISO format)
DAYER, R., ASSAL, Mathieu. Chronic diabetic ulcers under the first metatarsal head treated by staged tendon balancing: a prospective cohort study. In: Journal of bone and joint surgery. British volume, 2009, vol. 91, n° 4, p. 487–493. doi: 10.1302/0301-620X.91B4.21598
Main files (1)
Article
accessLevelRestricted
Identifiers
ISSN of the journal0301-620X
465views
0downloads

Technical informations

Creation04/23/2012 1:23:19 PM
First validation04/23/2012 1:23:19 PM
Update time03/14/2023 5:24:37 PM
Status update03/14/2023 5:24:37 PM
Last indexation02/12/2024 7:57:31 PM
All rights reserved by Archive ouverte UNIGE and the University of GenevaunigeBlack