Surgery Reduces Diabetic Foot Ulcers
Stretching the Achilles Tendon Lowers Risk of Recurring Foot Ulcers
July 31, 2003 -- The risk of foot ulcers, a major problem in diabetes, may be reduced by surgery to lengthen the Achilles tendon.
It's big news for people with diabetes, since small foot irritations can quickly develop into ulcers. Nerve damage to the foot caused by worsening diabetes, called diabetic neuropathy, prevents some diabetic people from realizing they have a foot injury.
"The return of ulcers has been a key concern," says lead researcher Michael J. Mueller, PhD, professor of physical therapy at Washington University School of Medicine in St. Louis, in a news release. His study appears in the Journal of Bone and Joint Surgery.
"If these wounds don't heal, there's a greater risk that a patient will have to have a portion or all of the foot amputated," he says. "This study shows that lengthening the Achilles tendon can have a dramatic effect on the problem of ulcer recurrence" caused by diabetic neuropathy.
In people with limited ankle mobility, the procedure helps shift the person's weight while walking from the ball of the foot to the heel, reducing pressure on the forefoot and decreasing the risk of skin breakdown, Mueller explains in his study. The heel has a good fat pad to protect against skin irritation -- the cause of infections and ulcers. For those who have diabetic neuropathy, the procedure could help relieve the concern about foot ulcers.
The 64 patients in Mueller's study were randomly assigned to have either a foot cast to keep pressure off the wound and let it heal or the Achilles tendon-lengthening surgery in addition to the foot cast. In the lengthening procedure, the foot is adjusted to stretch the tendon and then immobilized for six weeks to heal.
In the group that had only a cast, 88% of ulcers healed. In the group that had surgery and a cast, 100% of the ulcers healed.
Recurrence of foot ulcers is highest within the first month after patients start to walk again.
Seven months later, the surgery and cast group had 75% less risk of ulcer recurrences than the cast-only group. Two years later, the surgery and cast group had 53% less risk of ulcers.
"Lengthening the tendon causes some weakness in the calf muscles, which can cause unsteadiness, but can be improved with calf-strengthening exercises," says study co-author Jeffrey E. Johnson, MD, professor of orthopaedic surgery, in the news release.
For those with diabetic neuropathy, the procedure shows promise in reducing recurrent chronic foot ulcers.