Help with Os Peroneum excision

[Creflo]

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Coughlin and Mann has two summaries regarding excision of a painful/fractured os peroneum, but one aspect of the procedure isn't clear to me. Looking for advice regarding what to do with the distal portion of the longus tendon if you can't reapproximate the longus to itself once the ossicle is excised. One technique involves anastamosing the proximal portion of the longus to the brevis, but then what to do with the distal aspect of the longus? Thanks for any replies.

 

[sinustarsi]

I had great success by putting longus in cuboid laterally with biotenosis screw or cork screw. You cut the longus in half after removing the ossicle and put proximal portion in cuboid and distal portion can be secured to brevis near its insertion. This will control the 1st ray.

 

[hematosis]

I would consider an allogenic graft on standby in case you cannot reapproximate the longus tendon back together. Recently I have stoped doing tenodesis of brevis and longus as it now makes sense to me that these are very different tendons in terms of fucntion and strength (there is lots of good literature on this now). As long as you have good muscle excursion proximally, there is no need to sacrifice the longus tendon.