The narrowed forefoot at 1 year: an advanced approach for wound closure after central ray amputations

Central ray resections often result in a biomechanically unsound forefoot often accompanied by a cleft wound that is difficult to heal. Narrowing the forefoot enables the surgeon to close the plantar defect primarily, foregoing prolonged wound care and lowering the risk for postoperative complications. The authors present a technique of narrowing the forefoot using a small light-weight external fixation device that allows for immediate wound closure without adjacent metatarsal osteotomies. Four patients were treated with this technique, and all four healed in a timely fashion and resumed their previous lifestyle without skin breakdown. The forefoot narrowing technique results in a stable plantigrade forefoot in individuals at high risk for diabetes-related lower extremity reulceration and amputation.