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Foot and Ankle: R. Dayer and M. Assal Chronic diabetic ulcers under the first metatarsal head treated by staged tendon balancing: A PROSPECTIVE COHORT STUDY J Bone Joint Surg Br 2009; 91-B: 487-493 [Abstract] [Full text] [PDF]

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

James M Laborde   (6 May 2009)

Chronic diabetic ulcers under the first metatarsal head treated by staged tendon balancing 6 May 2009
James M Laborde, Orthopaedic Surgeon LSU Health Sciences Center, New Orleans,La. USA Send letter to journal: Re: Chronic diabetic ulcers under the first metatarsal head treated by staged tendon balancing monroe{at}laborde.net James M Laborde	Sir, I wish to congratulate the authors on this excellent article. It further supports the effectiveness of tendon lengthening for healing and preventing recurrence of forefoot ulcers. The results are similar to those previously published using gastrocnemius-soleus recession and peroneus longus lengthening, but including patients with infection and without pedal pulses.1 Dayer and Assal's only healing failure and transfer ulcer occurred in patients who did not have peroneus longus transfer. Perhaps their results would have been better if they had done peroneus longus transfer on all patients. Their foot procedures are probably best avoided in patients with local infection and without pedal pulses to avoid surgical complications in the foot. The need to add the foot procedures in other patients with ulcers still seems open to question. J.M. Laborde, Orthopaedic Surgeon, LSU Health Sciences Center, New Orleans, Louisiana, USA. 1. Laborde JM. Neuropathic plantar forefoot ulcers treated with tendon lengthenings. Foot Ankle Int 2008;29:378-84.