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Selective Plantar Fascia Release for Nonhealing Diabetic Plantar Ulcerations

Kim, J.-Young MD, PhD; Hwang, Seungkeun MD; Lee, Yoonjung MD, PhD

Journal of Bone & Joint Surgery - American Volume: 18 July 2012 - Volume 94 - Issue 14 - p 1297–1302
doi: 10.2106/JBJS.K.00198
Scientific Articles

Background: Achilles tendon lengthening can decrease plantar pressures, leading to resolution of forefoot ulceration in patients with diabetes mellitus. However, this procedure has been reported to have a complication rate of 10% to 30% and can require a long period of postoperative immobilization. We have developed a new technique, selective plantar fascia release, as an alternative to Achilles tendon lengthening for managing these forefoot ulcers.

Methods: We evaluated sixty patients with diabetes for a mean of 23.5 months after selective plantar fascia release for the treatment of nonhealing diabetic neuropathic ulcers in the forefoot. Preoperative and postoperative dorsiflexion range of motion of the affected metatarsophalangeal joint and wound-healing data were used to evaluate the effectiveness of the procedure and to determine the relationship between plantar fascia release and ulcer healing. Complications were recorded.

Results: Thirty-six (56%) of the ulcers healed within six weeks, including twenty-nine (60%) of the plantar toe ulcers and seven (44%) of the metatarsophalangeal joint ulcers. The mean range of motion of the affected metatarsophalangeal joint increased from 15.3° ± 7.8° to 30.6° ± 14.1° postoperatively (p < 0.05). All patients in whom the preoperative dorsiflexion of the affected metatarsophalangeal joint was between 5° and 30° and in whom the range of motion of that joint increased by ≥13° after the procedure experienced healing of the ulcer. No ulcer recurrence in the original location was identified during follow-up. No patients experienced any complications associated with the selective plantar fascia release.

Conclusions: Our results suggest that selective plantar fascia release can lead to healing of neuropathic plantar forefoot ulcers in diabetic patients. Ulcers in patients in whom the preoperative dorsiflexion angle of the affected metatarsophalangeal joint is between 5° and 30° and in whom the increase in range of motion is ≥13° postoperatively have the greatest chance of being cured.

Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of the levels of evidence.

1Foot and Ankle Center, Department of Orthopedic Surgery, Heymin General Hospital, 627-3, Jayang dong, Gwangjingu, Seoul, South Korea. E-mail address: kjyos@yahoo.co.kr

2Department of Orthopedic Surgery, Hankook General Hospital, Samdo 1-dong, Jeju City, Jejudo 690-715, South Korea. E-mail address: seungkeunh@hotmail.com

3Department of Ophthalmology, Hanyang University Guri Hospital, Kyomoon 1-dong, Guri City, Kyungido 471-701, South Korea. E-mail address: lyjot@hanyang.ac.kr

Copyright 2012 by The Journal of Bone and Joint Surgery, Incorporated
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