Abstract
Nonhealing wounds along the fifth metatarsal associated with neuropathy and bone deformity
frequently become complicated with osteomyelitis. Our surgical technique for complete
fifth ray amputation with peroneal tendon transfer has been previously published.
The present study evaluated the outcomes regarding success with initial healing and
intermediate-term limb survival after this procedure, which is intended to resolve
infection, remove bone deformity, heal and prevent recurrence of lateral column wounds,
and maintain functional stability of the foot. An institutional review board–approved
retrospective review of 21 consecutive cases was performed on patients who had undergone
complete fifth ray amputation from August 2006 to September 2015. Comorbid conditions
were assessed in relation to outcome. The typical stage 1 procedure involved complete
fifth toe and metatarsal amputation, antibiotic bead placement, and preliminary wound
closure. The stage 2 procedure was performed 2 weeks later and involved removal of
the antibiotic beads, biopsy and remodeling of the cuboid, and peroneus longus tendon
transfer to the cuboid. All cases involved ulceration along the fifth metatarsal.
Of the 21 patients, 10 (47.6%) had undergone previous partial fifth ray amputation
with recurrent ulceration at the residual metatarsal stump. Osteomyelitis of the fifth
metatarsal was confirmed by bone culture and/or positive pathologic findings for osteomyelitis
in 19 of 21 cases (90.5%). A total of 15 patients (71.4%) were completely healed at
10 weeks, and 10 patients (47.6%) required subsequent surgery, including 4 below-the-knee
amputations and 1 Symes amputation. The average follow-up period was 37.0 (range 2.9
to 105) months. Despite the 10 patients (47.6%) requiring revision surgery, the limb
salvage rate was 76.2% (16 of 21) at an average follow-up period of >3 years in this
high-risk patient population.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: September 01, 2016
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2016 by the American College of Foot and Ankle Surgeons. All rights reserved.
