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.
KeywordsForefoot Diabetic foot Ulcers Biomechanics Sagittal force Shear force Reducible deformity Nonreducible deformity Tendon rebalancing Osteotomy Exostectomy Amputation Function
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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