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Title

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

Authors
Dayer, R.
Published in Journal of Bone and Joint Surgery. British Volume. 2009, vol. 91, no. 4, p. 487-493
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 AdultAgedAnkle Joint/physiopathologyChronic DiseaseDiabetic Foot/pathology/physiopathology/*surgeryFemaleFollow-Up StudiesHumansMaleMiddle AgedProspective StudiesRange of Motion, ArticularTendon Transfer/*methodsTendons/*surgeryTreatment Outcome
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PMID: 19336809
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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. https://archive-ouverte.unige.ch/unige:19760

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Deposited on : 2012-04-23

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