Soft tissue reconstruction for the heel and plantar foot.

Soft tissue resurfacing after the ravages of injury or disease continues to be a formidable problem. A thorough understanding of the biomechanics of ambulation and the way in which weight is distributed over the sole of the foot is key to successful outcomes. Soft tissue repair has evolved from the simple filling of holes to a much more sophisticated approach. A plantar-grade foot that distributes the patient's weight in a uniform manner should be the goal. If this can be done without increasing the energy expenditure of ambulation, then surgeons certainly have done our patients an excellent service. Surgeons must not overlook the tendon imbalances and bony deformities that can accompany the effects of disease or trauma. The more complex soft tissue repair may not always be in the patient's best interests. Surgeons should use the simplest approach that can restore the limb to as close to its preinjury level of function as possible. A coordinated approach with plastic surgery, orthopedic surgery, vascular surgery, and podiatric surgery should be the standard of care for patients requiring plantar soft tissue repair.