Skip to main content
Log in

Foot reconstruction in weight bearing area

Long term results and gait analysis

  • Originals
  • Published:
European Journal of Plastic Surgery Aims and scope Submit manuscript

Summary

Multiple reconstructive procedures have been described for replacing skin loss in weight bearing areas of the foot. The reason for this is that the reconstruction of the plantar surface easily breaks down because of the particular structure of the soft tissues of this area. Furthermore, sensation is usually incomplete. For these reasons, stable, functional reconstruction is uncommon, even when using microvascular sensate skin flaps. In order to assess the best reconstructive management, functional long-term results of 13 patients who suffered from soft tissue defects of the weight-bearing areas of their feet were analyzed using gait analysis. The most reliable results were obtained with the Musgrave Footprint®. It stores the dynamic footprint on a computerized plate allowing to assess qualitatively and quantitatively pressure against time. This non-invasive method simultaneously analyzes pressure data from both feet. Furthermore, it allows the detection of areas about to break down. This may prevent ulcer formation by prophylactic management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Aldea PA et al (1986) The evolution of the surgical management of severe lower extremity trauma. Clin Plast Surg 13:549–569

    Google Scholar 

  2. Amarante J et al (1986) A new distally based fasciocutaneous flap of the leg. Br J Plast Surg 39:338–340

    CAS  PubMed  Google Scholar 

  3. Baker G et al (1990) Fasciocutaneous island flap based on the medial plantar artery. Plast Reconstr Surg 85:47–58

    Google Scholar 

  4. Blanc Y et al (1981) An inexpensive but durable foot-switch for telemetered locomotion studies. Biotelemetry Patient Monitoring 8:240–245

    Google Scholar 

  5. Boulton A (1987) The importance of abnormal foot pressures and gait in the causation of foot ulcers. H Connor J. Wiley and Sons Ltd

  6. Chang K et al (1986) Sensory reinnervation in microsurgical reconstruction of the heel. Plast Reconstr Surg 78:652–663

    Google Scholar 

  7. Chao E et al (1985) Gait analysis: a survey. In: Proceedings of the 1985 Uppsala Gait Analysis Meeting

  8. Chicarilli Z et al (1986) Complete plantar foot coverage with the free neurosensory radial forearm flap. Plast Reconstr Surg 78:94–100

    Google Scholar 

  9. Clodius L et al (1979) Die FuBsohle — Probleme der Rekonstruktion. Med Hyg 37:901–905

    Google Scholar 

  10. Dabb R et al (1984) Latissimus dorsi free flaps in the elderly: alternative to below-knee amputation. Plast Reconstr Surg 73:633–640

    Google Scholar 

  11. Dellon AL (1981) Evaluation of sensibility and reeducation of sensation in the hand. Williams and Wilkins, Baltimore, p 686

    Google Scholar 

  12. Donski P et al (1983) Distally based fasciocutaneous flap from the sural region. Scand J Plast Reconstr Surg 17:191–196

    Google Scholar 

  13. Grieve D et al (1966) The relationships between length of stride, step frequency, time of swing and speed of walking for children and adults. Ergonomics 5:379–399

    Google Scholar 

  14. Gumener R et al (1991) The reversed fasciosubcutaneous flap in the leg. Plast Reconstr Surg 88:1034–1041

    Google Scholar 

  15. Hallock G et al (1988) Restoration of the foot using the radial forearm flap. Ann Plast Surg 20:1–12

    Google Scholar 

  16. Harrison D et al (1981) The instep island flap to resurface plantar defects. Br J Plast Surg 34:315–318

    Google Scholar 

  17. Krupp S et al (1980) Probleme der Rekonstruktion von Fußsohlen. Chir Praxis 27:109–135

    Google Scholar 

  18. Laeteenmaeki T et al (1989) Recovery of sensation of free flaps. Scand J Plast Reconstr Surg 23:217–222

    Google Scholar 

  19. Magee JM (1988) L'evaluation clinique en orthopédie. Maloine, Paris

    Google Scholar 

  20. May J et al (1982) Microvascular transfer of free tissue for closure of bone wounds of the distal lower extremity. New Engl J Med 306:253–257

    Google Scholar 

  21. May J et al (1985) Free microvascular muscle flap with skin graft reconstruction of extensive defect of the foot: clinical and gait analysis. Plast Reconstr Surg 75:627–639

    Google Scholar 

  22. May J et al (1986) Foot reconstruction using free microvascular muscle flaps with skin grafts. Clin Plast Surg 13:681–689

    Google Scholar 

  23. McCarthy J et al (1990) Reconstructive surgery of the lower extremity. In: Plastic surgery. Saunders, Philadelphia, pp 4087–4088

    Google Scholar 

  24. Meland N (1990) Microsurgical reconstruction: the weightbearing surface of the foot. Microsurgery 11: 54–58

    Google Scholar 

  25. Mühlebauer W et al (1982) The forearm flap. Plast Reconstr Surg 70:336–341

    Google Scholar 

  26. Noever G et al (1986) Reconstruction of heel and sole defects by free flaps. Plast Reconstr Surg 78:345–350

    Google Scholar 

  27. Oberlin C et al (1988) La couverture par lambeau des pertes de substance cutanée de la jambe et du pied. Rev Chir Orthop 74:526–538

    Google Scholar 

  28. Okada T et al (1986) Coverage of heel defects of musculocutaneous and fasciocutaneous flap based on medial plantar neurovascular bundle. Eur J Plast Surg 9:117–121

    Google Scholar 

  29. Plas F et al (1989) La marche humaine. Masson, Paris

    Google Scholar 

  30. Ponten B (1981) The fascicutaneous flap: its use in soft tissue defects of the lower leg. Br J Plast Surg 34:215–220

    CAS  PubMed  Google Scholar 

  31. Rautio J et al (1989) Fußrekonstruktion mit freien Lappen. Handchir Mikrochir Plast Chir 21:227–234

    Google Scholar 

  32. Schwartz W et al (1985) The role of free tissue transfer in lower extremity reconstruction. Plast Reconstr Surg 76:364

    CAS  PubMed  Google Scholar 

  33. Shanahan R et al (1979) Medial plantar sensory flap for coverage of heel defects. Plast Reconstr Surg 64:295–298

    Google Scholar 

  34. Simon S et al (1981) Length-leg discrepancies in monoarticular of pauciarticular juvenil rheumatical arthritis. J Bone Joint Surg 63:209–215

    Google Scholar 

  35. Skef Z et al (1983) Heel coverage by a plantar myocutaneous island pedicle flap. Trauma 23:466–472

    Google Scholar 

  36. Sommerlad BC et al (1978) Resurfacing the sole: long-term follow-up and comparison of techniques. Br J Plast Surg 31:107–116

    Google Scholar 

  37. Song R et al (1982) The forearm flap. Clin Plast Surg 9:21–26

    Google Scholar 

  38. Stevenson T et al (1986) Management of foot injuries with freemuscle flaps. Plast Reconstr Surg 78:665–669

    Google Scholar 

  39. Takami H et al (1983) Microvascular free musculocutaneous flaps for the treatment of avulsion injuries of the lower leg. J Trauma 23:473–477

    Google Scholar 

  40. Tolhurst DE (1987) A comprehensive classification of flaps: the atomic system. Plast Reconstr Surg 80:608–609

    Google Scholar 

  41. Tschopp HM et al (1980) Probleme der Rekonstruktion bei Weichteildefekten der Fuß-Sohle. Med Hyg 814–819

  42. Vasconez LO et al (1979) Reconstructive procedures of the lower extremity. In: Plastic surgery. Grabb WC, New York, pp 811–817

    Google Scholar 

  43. Waters R et al (1976) Energy cost of walking of amputees. Arch Surg 58:42–46

    Google Scholar 

  44. Wee JT (1986) Reconstruction of the lower leg and foot with the reversed pediculed anterior tibial flap. Br J Plast Surg 40:327–337

    Google Scholar 

  45. Woltering E et al (1979) Split thickness skin grafting of the plantar surface of the foot after wide excision of neoplasms of the skin. Surg Gynecol Obstet 149:229–232

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Roggero, P., Blanc, Y. & Krupp, S. Foot reconstruction in weight bearing area. Eur J Plast Surg 16, 186–192 (1993). https://doi.org/10.1007/BF00175682

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00175682

Key words

Navigation