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

NewsBot · Mar 31, 2009

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

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.
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markjohconley · Apr 1, 2009

Re: Chronic diabetic ulcers under the first metatarsal head treated by staged

At what cost? (I don't mean financial)

NewsBot · Dec 16, 2009

Re: Chronic diabetic ulcers under the first metatarsal head treated by staged

Midfoot ulcers treated with gastrocnemius-soleus recession.
Laborde JM.
Foot Ankle Int. 2009 Sep;30(9):842-6.

BACKGROUND: Foot ulcers in patients with neuropathy are a common cause of hospital admission for infection sometimes resulting in amputation in patients with neuropathy. Tendon lengthening alone has been reported to be successful in treating neuropathic forefoot ulcers. Tendon lengthening has also been recommended as an adjunct to bony procedures (exostectomy or fusion) for treating midfoot ulcers. The author reports the results of gastrocnemius-soleus recession as the sole treatment of diabetic midfoot ulcers.

MATERIALS AND METHODS: This study evaluated the results of 11 patients with 11 neuropathic plantar midfoot ulcers who were treated primarily with gastrocnemius-soleus recession with an average followup of 39 months. Potentially risky bony procedures were done after tendon lengthening if ulcers did not heal or recurred.

RESULTS: Ten of the ulcers healed but one patient was lost to followup after his ulcer healed. One ulcer did not heal and one ulcer recurred but healed again after midfoot fusion. One patient later had a transfemoral amputation due to gangrene. Two patients later died from medical problems unrelated to their surgery. There were no incision problems, or transfer ulcers.

CONCLUSION: The author believes gastrocnemius-soleus recession as a primary treatment of diabetic midfoot ulcers is a low risk method of promoting ulcer resolution.
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NewsBot · Jun 19, 2010

FHL Tendon Transfer in Diabetics for Treatment of Non-Healing Plantar Heel Ulcers.
Kim JY, Lee I, Seo K, Jung W, Kim B.
Foot Ankle Int. 2010 Jun;31(6):480-5.

BACKGROUND: In diabetics, although heel ulcers occurring after Achilles tendon lengthening for managing forefoot ulcers are rare, they are a very troublesome complication. The purpose of this study was to evaluate the results of FHL tendon transfer for management of a plantar heel ulcer as a sequelae of insufficiency of the Achilles tendon in diabetic patients.

MATERIALS AND METHODS: Nine diabetic patients who underwent FHL tendon transfer for treatment of non-healing plantar heel ulcers due to insufficiency of the Achilles tendon for management of forefoot ulcers were treated between October 2005 and April 2007. All of the patients had undergone Achilles tendon lengthening with Hoke's triple hemisection method. The mean age was 55.9 +/- 9.7 years old. The average duration of a plantar heel ulcer was 11.9 +/- 3.8 months. The mean period of followup was 23.9 +/- 8.0 months. Between the occurrence of a heel ulcer and the FHL transfer, five of the patients underwent more than one attempt at direct Achilles tendon repair. The mean size of the wound was 1.2 +/- 0.6 cm(2). We assessed the healing time of the heel plantar ulcers and recurrence rates during followup periods. The complication rate and walking ability was also evaluated.

RESULTS: All of the plantar heel ulcers healed within 8 weeks after the operation and had not recurred as of the last followup. Two patients had recurrences of previous forefoot ulcers. One patient had a local infection in the FHL tendon transfer area. All of patients could walk without a brace or walking aid device after surgery.

CONCLUSION: We believe that Achilles tendon reconstruction using an FHL transfer for non-healing plantar heel ulcers resulting from a triple Hoke lengthening of the Achilles tendon is a good treatment option for diabetic patients.
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NewsBot · Jul 7, 2013

Retrospective Study of Non-Healing Neuropathic Forefoot Ulcers Treated with Gastrocnemius Recession
STEPHANIE JAMESON, RODNEY STUCK
American Diabetes Assoication; 73rd Scientific Sessions (2013); Chicago

Institutional Review Board approval was obtained at Edward Hines Veterans Affair (VA) and Loyola University Medical Center (LUMC) and a retrospective study was conducted using patients from both hospitals. Patients were included if they underwent a gastrocnemius recession for the history of a non- healing neuropathic plantar forefoot ulcerations from January 2010 to July 2012. Patients undergoing the procedure for another diagnosis were excluded in this study. Twenty patient charts were reviewed, which included nineteen patients were from the VA, and one patient from LUMC. All surgeries were performed by a single surgeon (R.S). Pre-operative, peri, and post operative data was collected from all patients who had the gastrocnemius recession procedure, CPT code 26787. The charts of sixteen diabetic male patients (20 feet) with an average age of 62 years old, were reviewed in total from Hines VA (19 patients) and Loyola University Medical Center (1 patient). Eighteen out of the twenty (90%) ulcerations healed, and only two ulcers re-ulcerated in the same location of previous ulceration. The average time of wound closure was 29 days post gastrocnemius recession. There were no transfer ulcerations. Two patients died of unrelated events following resolution of their ulcerations. The average length of time the patient had the ulceration pre-operatively was 12.35 years and the average followup was 17.4 months. A tendon lengthening should be a treatment option once any underlying infection has been appropriately treated and the vascular status has been shown to be appropriate for wound healing. A gastrocnemius recession should be considered in neuropathic patients who have failed to respond to conservative wound care, including application of serial human derived dermal substitute grafts when appropriate for the treatment of plantar forefoot ulcerations
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markjohconley Well-Known Member

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NewsBot The Admin that posts the news.

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