Flexor Hallucis Longus and Extensor Digitorum Longus Tendon Transfers for Balancing the Foot Following Transmetatarsal Amputation

Transmetatarsal amputation is a useful surgical procedure that is applicable to the treatment of the dysvascular, neuropathic, and/or traumatized forefoot. Because of the loss of the insertions of some of the extrinsic pedal musculature, transmetatarsal amputation is known to be associated with imbalance of the residual foot, and this can lead to complications related to cutaneous compromise, as well as difficulties with bracing and shoe fit. In this techniques report, we describe a combination of tendon transfers that use flexor hallucis longus and extensor digitorum longus, which can be useful in preventing pedal imbalance following transmetatarsal amputation.