title: Salvage of the neuropathic foot by using bone resection and tendon balancing: a retrospective review of 10 patients.
abstract: Medical records were retrospectively reviewed for 10 patients (mean age, 48.7 years) who had a chronic, recurrent neuropathic forefoot ulceration or osteomyelitis in the presence of an abnormal metatarsal parabola. Two patients had multiple lesser metatarsal osteomyelitis, 3 patients had chronic ulceration in the presence of an abnormal metatarsal parabola, and 5 patients had previous lesser ray resection or metatarsal head resection. None of the patients had signs of skin breakdown under the first metatarsal. All of the patients were treated with a combination gastrocnemius recession, peroneus longus to peroneus brevis tendon transfer, and resection of the second through fifth metatarsal heads to decrease plantar forefoot pressure and preserve the first ray without increasing the risk of ulceration under the first metatarsal head. All patients achieved a healed plantigrade foot without ulcer recurrence, transfer callus development, or contralateral foot breakdown at a mean follow-up of 14.2 months. Postsurgical complications consisted of dehiscence of various incision sites on 3 individual patients and one local reaction to antibiotic-impregnated beads. This preliminary study suggests that this combination of reconstructive procedures may provide an alternative method of foot salvage to panmetatarsal resection and transmetatarsal amputation.
authors.affiliation: Department of Orthopedics and Podiatric Surgery, Kaiser Permanente Medical Center, Oakland, CA, USA. graham.a.hamilton@kp.org
authors.forename: Graham A
authors.initials: GA
authors.lastname: Hamilton
authors.forename: Lawrence A
authors.initials: LA
authors.lastname: Ford
authors.forename: Hugo
authors.initials: H
authors.lastname: Perez
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Rush
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D017719:Diabetic Foot / Q000601:surgery*; D006801:Humans; D008682:Metatarsal Bones / Q000601:surgery*; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery*; D012189:Retrospective Studies; D016879:Salvage Therapy; D013709:Tendon Transfer; D016896:Treatment Outcome