Long-Term Outcomes Following EHL Jones Tenosuspension With or Without Peroneus Longus to Brevis Transfer for First Metatarsal Head Ulcers in Patients With Diabetes.

Abstract

Background: Forefoot ulcers, particularly those beneath the first metatarsal head (MTH), are a common and serious complication in patients with diabetes. These ulcers typically result from elevated plantar pressures and loss of protective sensation due to peripheral neuropathy. We conducted this study to evaluate long-term outcomes following EHL Jones tenosuspension, with or without peroneus longus to brevis tendon transfer, in promoting healing of first metatarsal head ulcers in patients with diabetes.

Methods: The retrospective study of 45 patients with diabetes and a plantar first metatarsal head ulcer who underwent extensor hallucis longus (EHL) Jones tenosuspension with or without a concomitant peroneus longus to brevis tendon transfer during the study period. They were divided into 2 groups: group 1 included those who had undergone a modified EHL Jones transfer with peroneus longus to brevis tendon transfer; and group 2, who had undergone a modified EHL Jones transfer only. We studied the long-term wound healing rates from patient records and then did a prospective survey of the post-review period.

Results: In group 1, the mean time for the ulcers to heal was 5.3 weeks, and in group 2, it was 6.2 weeks. One ulcer failed to heal in group 1, and 2 in group 2. In group 1, 1 patient had a recurrence of the first metatarsal head ulcer, while 3 had transfer lesions under the lesser metatarsal heads. In group 2, 1 patient reported a recurrence at the first metatarsal head region and subsequently underwent a peroneus longus to brevis transfer.

Conclusion: We observed high recurrence-free healing rates (approaching 95% at 30 months) following EHL Jones tenosuspension with or without peroneus longus to brevis transfer in patients with diabetes and plantar first metatarsal head ulcers. Although findings are encouraging, the absence of a formal comparator group and the small number of patients treated with the single procedure limit definitive conclusions regarding comparative effectiveness.