Logo of The Journal of Bone & Joint Surgery (Br)
Quick search:        
          Advanced Search
Guest Access | Sign In
Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 4, 487-493.
doi: 10.1302/0301-620X.91B4.21598  
Copyright © 2009 by British Editorial Society of Bone and Joint Surgery
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow View responses
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow My Folders
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Dayer, R.
Right arrow Articles by Assal, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Dayer, R.
Right arrow Articles by Assal, M.

Chronic diabetic ulcers under the first metatarsal head treated by staged tendon balancing

A PROSPECTIVE COHORT STUDY

R. Dayer, MD, Orthopaedic Chief Resident1; and M. Assal, MD, Orthopaedic Lecturer1

1 Department of Orthopaedics, University of Geneva Hospitals, 24 rue Micheli-du-Crest, 1211 Geneva 14, Switzerland.

Correspondence should be sent to Dr R. Dayer; e-mail: romain.dayer{at}hcuge.ch

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° 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.




eLetters:

Read all eLetters

Chronic diabetic ulcers under the first metatarsal head treated by staged tendon balancing
James M Laborde
J Bone Joint Surg Br Online, 6 May 2009 [Full text]

(c) British Editorial Society of Bone and Joint Surgery All Rights Reserved
Registered charity no: 209299     Print ISSN: 0301-620X
Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General