Achilles tendon lengthening

Increased pressure on the plantar aspect of the forefoot has been shown to be associated with limited joint mobility and with equinus deformity of the ankle. In the

5th Metatarsal Head Excision

Fig. 8.16 Technique for 5th metatarsal head resection. Before and after removal of the metatarsal head. Note that the osteotomy is angled in an oblique manner at the surgical neck of the metatarsal.

Fig. 8.17 (a) Preoperative anteroposterior radiograph reveals deformity of the right 5th metatarsophalangeal joint with lateral bowing and prominence of the 5th metatarsal head, (b) Postoperative anteroposterior radiograph reveals resection of the 5th metatarsal head.

Fig. 8.17 (a) Preoperative anteroposterior radiograph reveals deformity of the right 5th metatarsophalangeal joint with lateral bowing and prominence of the 5th metatarsal head, (b) Postoperative anteroposterior radiograph reveals resection of the 5th metatarsal head.

5th Metatarsal

presence of peripheral neuropathy, elevated pressure beneath one or more metatarsal heads can result in the development of ulceration. Ankle equinus may also contribute to the development of Charcot's osteoarthropathy with collapse of the mid-foot or avulsion fracture of the posterior process of the calcaneus. Armstrong and coworkers, at the University of Texas Health Science Centre at San Antonio, reported on a study to determine the degree to which pressure on the plantar aspect of the forefoot is reduced following percutaneous lengthening of the Achilles tendon in high-risk subjects with diabetes. They demonstrated that peak plantar forefoot pressures were reduced by approximately 27% following percutaneous Achilles tendon lengthening. These authors suggest that lengthening of the Achilles tendon, in high-risk patients with diabetes, may decrease the likelihood of ulceration and may increase the efficacy of pressure-reduction modalities such as casts or braces. In fact, this procedure facilitates the healing of recalcitrant forefoot plantar ulcers.

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