Surgery to lengthen the Achilles tendon significantly reduces the risk that people with diabetes will suffer return bouts of foot ulcers. A recent study showed that patients who had the operation cut their ulcer risk in half or more. About 15% of people with diabetes develop ulcers on their feet. Even after treatment, these ulcers often come back.
"The return of these ulcers has been a key concern for patients and their clinicians," says principal investigator Michael J. Mueller, associate director of the program in physical therapy at Washington University School of Medicine, St. Louis.
"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," Mueller says. "This study shows that lengthening the Achilles tendon can have a dramatic effect on the problem of ulcer recurrence."
Limited ankle mobility is often a cause of foot ulcers, so lengthening the Achilles tendon, which allows greater movement, often resolves the problem of a recurrence. In addition, the cast immobilizes the foot, reducing the chances of getting an injury that may go unnoticed. Nerve damage in diabetics may cause them to lose sensation in their feet, allowing undetected injuries to occur and fester.
The study included 64 people with diabetes who all had an ulcer on the ball of the foot. None had had an amputation. They were divided into two groups. The first group received a foot cast—the standard treatment—while the second group received both a cast and the surgery.
After seven months, the group that received the cast and the surgery was 75% less likely to have an ulcer recurrence than the group that received the cast only. After two years, the surgery group was 52% less likely to have an ulcer recurrence.
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