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Plantar fascia release for nonhealing diabetic plantar ulcer

Discussion in 'Diabetic Foot & Wound Management' started by NewsBot, Jul 21, 2012.

  1. NewsBot

    NewsBot The Admin that posts the news.


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    Selective plantar fascia release for nonhealing diabetic plantar ulcerations.
    Kim JY, Hwang S, Lee Y.
    J Bone Joint Surg Am. 2012 Jul 18;94(14):1297-302
  2. Admin2

    Admin2 Administrator Staff Member

  3. I'd like to see the long term follow up with this procedure. I think it was Dr Javier Pascual Huerta that I was talking to regarding Charcot joint aetiology. As I recall, his contention was that it was preceded by a rupture of the plantar fascia.
  4. Craig Payne

    Craig Payne Moderator


    Limited joint mobility and plantar fascia function in Charcot's neuroarthropathy
    V. Chuter, C. Payne
    Diabetic Medicine; Volume 18, Issue 7, pages 558–561, July 2001
  5. Jeff S

    Jeff S Active Member

    Interesting concept
  6. Intrinsic minus foot-type = increase load on plantar fascia +glycosylation of plantar fascia = plantar fascia rupture = increased inter-osseous compression and joint trauma = Charcot neuropathy

    Something like that.

    So, should foot orthoses that are designed to reduce tensile loading in the plantar fascia be prescribed prophylactically in diabetic populations?
  7. Jeff S

    Jeff S Active Member

    Along the same lines, an acquired pes cavus foot type develops w/intrinsic minus atrophy associated extensor substitution hammertoes, etc. Also, if you buy that the AGE's stiffen the PF, the Achilles is also affected. It exerts a much more powerful plantarflexory force. I would be hesitant to lengthen it in this particular intrinsic minus foot type vs Steindler stripping (not just PF release). The vast majority of my Charcot patients do not have a cavus foot-type asnd therefore, I do a percutaneous TAL with 90% of all my Charcot patients, whether a reconstructive procedure is performed or not. That said, interesting concept indeed.
  8. drsha

    drsha Banned

    Both Tendo Achilles and Plantar Fascial releases are biomechanically unsound (less so in the rigid rearfoot functional foot types) gifting the patient to a healed ulcer and a poorer quality of life for their remaining years which seemingly, is not being considered.

    I thought that we were biomechanically oriented foot surgeons?

    Isn't there a better way?

    I have healed 7000 wounds+ in my career and I have never done a TAL (illegal in New York State for DPM's until recently) or PF release on any of them.

    My goals include improving the quality of life for the involved individuals as I heal wounds.

  9. drsha

    drsha Banned

    I do this all the time however, I call this preventive and quality of life upgrading not prophylactic and I can be more selective than considering all diabetics as you suggest.

    They should be dispensed foot type-specific to the stable and flexible rearfoot, stable and flexible forefoot FFT's, especially in the face of other risk factors such as obesity, functional deficits, high energy occupations and lifestyles, etc.


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