Abstract
Many diabetic patients with foot ulcers tend to exhibit restricted dorsiflexion in the ankle joint, which can arise for a variety of reasons. Diabetic patients with nerve disorders are at particular risk of recurrent ulceration of the forefoot, even if appropriate insoles or molded shoes are created, and the patient is non-weight-bearing. We performed transcutaneous Achilles tendon lengthening in 4 limbs belonging to 4 individuals. By improving the movement restrictions seen during dorsiflexion of the ankle joint, we were able to control recurrent ulceration in the forefoot. The present report documents our experiences with these cases. Aimlessly continuing conservative treatment for recurrent ulceration can ultimately lead to the exacerbation of the ulceration or infection, and thus, represents a major risk factor, as it can lead to long-term hospitalization or even amputation in some cases. In order to enable diabetic patients to live actively without ulceration for as long as possible, further aggressive preventative therapy must also be considered. Transcutaneous Achilles tendon lengthening is a typical “surgical off-loading” procedure that ameliorates range of motion restrictions in the ankle joint, and thus, represents a highly effective procedure that can help to prevent the onset and recurrence of forefoot ulceration. However, special consideration is required regarding the potential complications of and patient eligibility for this procedure.
