Tendon Lenthenings for Forefoot Ulcers

admin · Jun 19, 2005

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Tendon Lenthenings for Forefoot Ulcers

The objective of this study was to determine if plantar forefoot ulcers would heal and not recur if treated with tendon lengthenings. Patients with neuropathy (usually from diabetes mellitus) and plantar forefoot ulcers were treated with tendon lengthening and followed. Of 34 forefoot ulcers treated with tendon lengthenings, 1 did not heal, and 4 recurred at the same location by 36 months average follow-up. Three patients developed transfer ulcers at other locations on the foot. Two patients subsequently required leg amputation for gangrene (1 transfemoral and 1 transtibial). No amputations were completed for progressive infection from ulcers. Tendon lengthening appears to be an effective treatment for neuropathic plantar forefoot ulcers.
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Full text of article from Wounds is available at Medscape (free registration required)

NewsBot · Apr 30, 2008

Neuropathic plantar forefoot ulcers treated with tendon lengthenings.
Laborde JM.
Foot Ankle Int. 2008 Apr;29(4):378-84.

BACKGROUND: Foot ulcers are a common cause of infection and amputation in patients with neuropathy. This retrospective study evaluated the healing and recurrence rates after treating neuropathic ulcers plantar to the metatarsal heads with tendon lengthenings in the leg.

MATERIALS AND METHODS: Between 1995 and 2003, 20 ulcers plantar to the metatarsal heads in 17 patients were treated with tendon lengthenings. All patients had gastroc-soleus recession (Vulpius procedure). Patients with first metatarsal head ulcers also had Z-type lengthenings of the peroneus longus. Patients with fifth metatarsal head ulcers also had intramuscular lengthening of the tibialis posterior. Patients with second, third, and fourth metatarsal head ulcers had only a gastroc-soleus recession.

RESULTS: All patients had neuropathy; 15 patients with 17 ulcers had diabetes mellitus. All incisions healed primarily without infection. Nineteen of 20 ulcers healed. One patient with one ulcer was lost to followup after the ulcer healed. Average followup for the remaining 19 ulcers was 45 months. Average duration of the 19 ulcers before surgery was 17 months. Three of 19 ulcers recurred and had repeat tendon lengthening and healed again. None of the patients whose ulcers healed had to be admitted for foot infection or amputation. The one patient whose ulcer did not heal developed progressive dry gangrene which required trans-femoral amputation six months after tendon lengthening.

CONCLUSION: Tendon lengthenings in the leg seem to be effective in healing and preventing recurrence of neuropathic ulcers plantar to the metatarsal head with a low complication rate.
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NewsBot · Jul 12, 2016

Gastrocnemius Fascia Release under Local Anaesthesia as a Treatment for Neuropathic Foot Ulcers in Diabetic Patients: a short series.
Van Bael K et al
Acta Chir Belg. 2016 May 24:1-18

BACKGROUND:
Diabetic foot ulceration is the leading cause of major amputation in the developed world. Plantar neuropathic ulcers at the forefoot can be managed conservatively with off-loading but treatment is not invariably successful. Achilles-tendon lengthening procedures aim at increasing dorsiflexion and decreasing forefoot pressure, but can be associated with complications and require prolonged postoperative immobilization to prevent tendon rupture. We assessed the feasibility and clinical outcome of a comparative minimal invasive procedure: the gastrocnemius fascia release. This technique targets the same goals but is performed under local anesthesia and allows immediate postoperative weight-bearing and ambulation.
METHODS:
Diabetic patients with plantar neuropathic ulcers Wagner grade 2 or 3 were recruited from our diabetic foot clinic. Patients with infected wounds or untreatable peripheral arterial disease were excluded from the study. Conservative treatment with off-loading and local wound care was attempted for six weeks and surgical procedure only contemplated upon failure. Primary end-points were improved range of dorsiflexion and time-to-healing. Secondary end-points were local ulcer recurrences, new plantar ulcers and minor or major amputation. Postoperative follow-up was 12 months.
RESULTS:
7 patients were included in the study. An improvement in dorsiflexion of 10.4? (mean) was recorded postoperatively (p < 0.01). After 30 days, complete healing was accomplished in 6 of the 7 patients. Long-term results were excellent as no ulcer recurrence or amputation was noted.
CONCLUSIONS:
Gastrocnemius fascia release under local anaesthesia can be performed safely in diabetic patients with plantar neuropathic ulcers under the metatarsal heads. Clinical outcome is excellent and long-term results promising.
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