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Forefoot Operations

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Interventional Treatment of Wounds

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Abstract

Forefoot operations are often necessary for wound healing. Beyond the goal of soft tissue defect closure or coverage, the underlying etiology must be addressed. Biomechanical abnormalities can contribute to the development and chronicity of wounds in the forefoot. Thus, forefoot surgery includes procedures involving soft tissue, tendon, and bone to address the altered biomechanics. These procedures attempt to neutralize the deforming forces caused by the biomechanical abnormalities. Ultimately, preservation or improvement of function is the most important consideration for procedure selection.

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References

  1. Cavanagh PR, Ulbrecht JS, Caputo GM. New developments in the biomechanics of the diabetic foot. Diabetes Metab Res Rev. 2000;16(Suppl 1):S6–S10.

    Article  PubMed  Google Scholar 

  2. Attinger CE, Brown BJ. Amputation and ambulation in diabetic patients: function is the goal. Diabetes Metab Res Rev. 2012;28(Suppl 1):93–6.

    Article  PubMed  Google Scholar 

  3. Wukich DK, McMillen RL, Lowery NJ, Frykberg RG. Surgical site infections after foot and ankle surgery: a comparison of patients with and without diabetes. Diabetes Care. 2011;34(10):2211–3.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Attinger CE, Evans KK, Bulan E, Blume P, Cooper P. Angiosomes of the foot and ankle and clinical implications for limb salvage: reconstruction, incisions, and revascularization. Plast Reconstr Surg. 2006;117(7 Suppl):261S–93S.

    Article  CAS  PubMed  Google Scholar 

  5. Forsythe RO, Hinchliffe RJ. Assessment of foot perfusion in patients with a diabetic foot ulcer. Diabetes Metab Res Rev. 2016;32(Suppl 1):232–8.

    Article  CAS  PubMed  Google Scholar 

  6. Dalal S, Widgerow AD, Evans GR. The plantar fat pad and the diabetic foot – a review. Int Wound J. 2015;12(6):636–40.

    Article  PubMed  Google Scholar 

  7. Peters EJ, Armstrong DG, Lavery LA. Risk factors for recurrent diabetic foot ulcers: site matters. Diabetes Care. 2007;30(8):2077–9.

    Article  PubMed  Google Scholar 

  8. Yavuz M, Erdemir A, Botek G, Hirschman GB, Bardsley L, Davis BL. Peak plantar pressure and shear locations: relevance to diabetic patients. Diabetes Care. 2007;30(10):2643–5.

    Article  PubMed  Google Scholar 

  9. Arosi I, Hiner G, Rajbhandari S. Pathogenesis and treatment of callus in the diabetic foot. Curr Diabetes Rev. 2016;12(3):179–83.

    Article  CAS  PubMed  Google Scholar 

  10. Davis B, Crow M, Berki V, Ciltea D. Shear and pressure under the first ray in neuropathic diabetic patients: implications for support of the longitudinal arch. J Biomech. 2017;52:176–8.

    Article  PubMed  Google Scholar 

  11. Frykberg RG, Bevilacqua NJ, Habershaw G. Surgical off-loading of the diabetic foot. J Vasc Surg. 2010;52(3 Suppl):44S–58S.

    Article  PubMed  Google Scholar 

  12. Urfalioglu A, Gokdemir O, Hanbeyoglu O, Bilal B, Oksuz G, Toker M, et al. A comparison of ankle block and spinal anesthesia for foot surgery. Int J Clin Exp Med. 2015;8(10):19388–93.

    PubMed  PubMed Central  Google Scholar 

  13. Lichtenfeld NS. The pneumatic ankle tourniquet with ankle block anesthesia for foot surgery. Foot Ankle. 1992;13(6):344–9.

    Article  CAS  PubMed  Google Scholar 

  14. Cardinal M, Eisenbud DE, Armstrong DG, Zelen C, Driver V, Attinger C, et al. Serial surgical debridement: a retrospective study on clinical outcomes in chronic lower extremity wounds. Wound Repair Rregen. 2009;17(3):306–11.

    Article  Google Scholar 

  15. Cook EA, Cook JJ, Badri H, Mostafa J. Bioengineered alternative tissues. Clin Podiatr Med Surg. 2014;31(1):89–101.

    Article  PubMed  Google Scholar 

  16. Lavery LA, Fulmer J, Shebetka KA, Regulski M, Vayser D, Fried D, et al. The efficacy and safety of Grafix((R)) for the treatment of chronic diabetic foot ulcers: results of a multi-centre, controlled, randomised, blinded, clinical trial. Int Wound J. 2014;11(5):554–60.

    Article  PubMed  Google Scholar 

  17. Garwood CS, Steinberg JS. Soft tissue balancing after partial foot amputations. Clin Podiatr Med Surg. 2016;33(1):99–111.

    Article  PubMed  Google Scholar 

  18. Scott JE, Hendry GJ, Locke J. Effectiveness of percutaneous flexor tenotomies for the management and prevention of recurrence of diabetic toe ulcers: a systematic review. J Foot Ankle Res. 2016;9:25.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Mueller MJ, Sinacore DR, Hastings MK, Strube MJ, Johnson JE. Effect of Achilles tendon lengthening on neuropathic plantar ulcers. A randomized clinical trial. J Bone Joint Surg Am. 2003;85-A(8):1436–45.

    Article  PubMed  Google Scholar 

  20. Dayer R, Assal M. Chronic diabetic ulcers under the first metatarsal head treated by staged tendon balancing: a prospective cohort study. J Bone Joint Surg Br. 2009;91(4):487–93.

    Article  CAS  PubMed  Google Scholar 

  21. Laurinaviciene R, Kirketerp-Moeller K, Holstein PE. Exostectomy for chronic midfoot plantar ulcer in Charcot deformity. J Wound Care. 2008;17(2):53–5, 7–8.

    Google Scholar 

  22. Molines-Barroso RJ, Lazaro-Martinez JL, Aragon-Sanchez J, Garcia-Morales E, Carabantes-Alarcon D, Alvaro-Afonso FJ. The influence of the length of the first metatarsal on the risk of reulceration in the feet of patients with diabetes. Int J Low Extrem Wounds. 2014;13(1):27–32.

    Article  PubMed  Google Scholar 

  23. Eschler A, Gradl G, Wussow A, Mittlmeier T. Prediction of complications in a high-risk cohort of patients undergoing corrective arthrodesis of late stage Charcot deformity based on the PEDIS score. BMC Musculoskelet Disord. 2015;16:349.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Chu YJ, Li XW, Wang PH, Xu J, Sun HJ, Ding M, et al. Clinical outcomes of toe amputation in patients with type 2 diabetes in Tianjin. China Int Wound J. 2016;13(2):175–81.

    Article  PubMed  Google Scholar 

  25. Izumi Y, Satterfield K, Lee S, Harkless LB. Risk of reamputation in diabetic patients stratified by limb and level of amputation: a 10-year observation. Diabetes Care. 2006;29(3):566–70.

    Article  PubMed  Google Scholar 

  26. Thorud JC, Jupiter DC, Lorenzana J, Nguyen TT, Shibuya N. Reoperation and reamputation after transmetatarsal amputation: a systematic review and meta-analysis. J Foot Ankle Surg. 2016;55(5):1007–12.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Georgetown University School of Medicine, Washington, DC, 20007, USA

    Paul J. Kim DPM, MS

  2. Division of Wound Healing and Hyperbaric Medicine, Department of Plastic Surgery, MedStar Georgetown University Hospital, Bles 1st Floor, 3800 Reservoir Road NW, Washington, DC, 20007, USA

    Paul J. Kim DPM, MS

Authors
  1. Paul J. Kim DPM, MS
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Corresponding author

Correspondence to Paul J. Kim DPM, MS .

Editor information

Editors and Affiliations

  1. Division of Plastic Surgery, Brigham and Women’s Hospital Harvard Medical School, Boston, Massachusetts, USA

    Dennis P. Orgill

Electronic Supplementary Material

Intraoperative video of a Z tendon lengthening of the anterior tibial tendon on the right foot. Careful dissection is made through the skin and subcutaneous tissue. The tendon sheath is then incised to expose the tendon. The tendon is that hemi-transected with a proximal and lateral incision along with a central incision. The tendon is now in an elongated position. The tendon can now be anastomosed and the overlying soft tissue is closed (MP4 721171 kb)

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Kim, P.J. (2018). Forefoot Operations. In: Orgill, D. (eds) Interventional Treatment of Wounds. Springer, Cham. https://doi.org/10.1007/978-3-319-66990-8_6

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  • DOI: https://doi.org/10.1007/978-3-319-66990-8_6

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-66989-2

  • Online ISBN: 978-3-319-66990-8

  • eBook Packages: MedicineMedicine (R0)

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