Achilles Tendon Lengthening: Friend or Foe in the Diabetic Foot?

PATIENTS AND METHODS

This study is a nonrandomized, nonblinded, retrospective review focused on diabetic patients with plantar forefoot or midfoot ulceration who underwent surgical soft-tissue reconstruction. The study periods span from 1983 to 1991 and from 1996 to 2004, using records from our diabetic foot registry.

Patients in the earlier group underwent wound closure surgery without simultaneous Achilles tendon–lengthening surgery. In contrast, the later group included only those patients who underwent Achilles tendon–lengthening surgery as part of their reconstructive treatment if their preoperative evaluation showed equinus deformity and Achilles tendon tightness.

All surgical patients were referred after the failure of conservative management, including local wound care and offloading, with conditions documented as Wagner-Meggitt grade 2, 3, or 4 wounds.

RESULTS

The study compared two groups, the early group consisting of 179 diabetic forefoot or midfoot ulcers in 149 patients, and the later group, which included 145 ulcers in 138 patients. The later group patients also underwent Achilles tendon–lengthening surgery, which resulted in significantly reduced recurrence of ulcers.

A multivariate Cox regression model indicated that Achilles tendon lengthening decreased the relative risk of recurrence by 94 percent compared to the early group.

DISCUSSION

Lengthening of the Achilles tendon has been shown to prevent plantar ulceration effectively in diabetic patients with neuropathy. This surgical intervention, along with proper wound management, has proven to reduce the rates of ulcer recurrence and the need for further invasive procedures.

Our study supports the integration of Achilles tendon lengthening into the surgical management of diabetic foot ulcers to enhance patient outcomes and reduce complications associated with recurrent ulcerations.

CONCLUSIONS

The inclusion of Achilles tendon lengthening in surgical protocols for diabetic foot ulcers has demonstrated significant benefits in reducing recurrence rates, advocating for its consideration as a standard practice in diabetic foot management.