Tendon balancing in pedal amputations

Pedal amputations are necessary procedures performed by a foot and ankle surgeon that may lead to gross positional deformities of the foot. To achieve a plantigrade foot, proper balancing of the foot is required often through the use of tendon transfers and lengthening. This article describes the basic tendon transfers needed to achieve a successful outcome when performing various pedal amputations. A case is presented in which Achilles tendon lengthening was used to heal a forefoot ulcer. A full understanding of tendon function and transfer techniques is paramount for surgeons performing pedal amputations. By rebalancing the foot, patients are able to ambulate with custom shoes or bracing, and more proximal amputations, which can be physically and psychologically devastating, are prevented.