Lengthening of the Achilles tendon in diabetic patients who are at high risk for ulceration of the foot

Background The purpose of this study was to determine the degree to which p ressure on the plantar aspect of the forefoot is reduced following percutan eous lengthening of the Achilles tendon in diabetic patients who are at hig h risk for ulceration of the foot. Methods: Ten diabetic patients who had a history of neuropathic plantar ulc eration of the forefoot were enrolled in a laboratory gait trial. A repeate d-measures design and a computer analysis of force-plate data were used to examine dynamic pressures on the forefoot,,vith the patient walking barefoo t, immediately before percutaneous lengthening of the Achilles tendon and a t eight weeks afterward. Although the wound in each patient had healed at l east one month before the operation, we considered the patients to be at hi gh risk for ulceration because they had had an ulcer previously. Results: The mean peak pressure (and standard deviation) on the plantar asp ect of the forefoot decreased significantly from 86 +/- 9.4 newtons per squ are centimeter preoperatively to 63 +/- 13.2 newtons per square centimeter at eight weeks postoperatively (p < 0.001), Commensurately, the mean dorsif lexion of the ankle joint increased significantly from 0 +/- 3.1 degrees pr eoperatively to 9 +/- 2.3 degrees at eight weeks postoperatively (p < 0.001 ), Conclusions: The results of this study suggest that peak pressures on the p lantar aspect of the forefoot are significantly reduced following percutane ous lengthening of the Achilles tendon in diabetic patients who are at high risk for ulceration of the foot. We are unaware of any other reports in th e medical literature that describe such findings. These data may lend suppo rt to studies that have indicated that this procedure should be used as an adjunctive therapeutic or prophylactic measure to reduce the risk of neurop athic ulceration.