Tibial cortex transverse transport: Historical evolution, clinical applications, and future directions

<h2>Abstract</h2> Diabetic foot ulcers are among the most severe complications of diabetes mellitus, often leading to high morbidity, major amputations, and premature mortality. Despite advancements in wound care and limb salvage techniques, treatment failures remain prevalent. Tibial cortex transverse transport (TCT), leveraging principles of distraction osteogenesis, offers a unique approach by directly stimulating microvascular perfusion and tissue regeneration in ischemic limbs, addressing limitations of conventional therapies. Despite its potential and documented use elsewhere, TCT remains underutilized and less studied within Western healthcare systems, representing a significant knowledge gap. This paper provides a comprehensive review of the historical evolution of tibial cortex transverse transport, its underlying biomechanics, surgical methodology, and clinical applications. By tracing the origins of this procedure, detailing its mechanism of action, and discussing modern adaptations and future utilities, we aim to provide a foundation for wide adoption and refinement of this technique, particularly in Western medicine. <h3>Level of Clinical Evidence</h3> V