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Achilles Tendon Lengthening: Friend or Foe in the Diabetic Foot?

Colen, Lawrence B. M.D.; Kim, Claudia J. M.D.; Grant, William P. D.P.M., F.A.C.F.S.; Yeh, Jiun-Ting M.D.; Hind, Baydoun Ph.D., M.P.H.

Plastic and Reconstructive Surgery: January 2013 - Volume 131 - Issue 1 - p 37e–43e
doi: 10.1097/PRS.0b013e3182729e0b
Reconstructive: Lower Extremity: Original Articles

Background: Literature in the past decade has shown that Achilles tendon–lengthening surgery in addition to total contact casting decreases the rate of plantar ulcer recurrence in the forefoot and midfoot; however, the risk of heel ulceration or recurrent equinus deformity with new forefoot or midfoot wounds is not insignificant. The purpose of this study was to compare the rate of recurrent ulceration between the patient groups who have undergone soft-tissue repair of diabetic forefoot or midfoot wounds either with or without concomitant Achilles tendon–lengthening surgery.

Methods: All diabetic patients with plantar forefoot or midfoot ulceration who underwent soft-tissue reconstruction during two different time periods—from 1983 to 1991 or from 1996 to 2004—were reviewed. Multiple patient-related factors were compared. The “early group” consisted of 179 wounds in 149 patients who underwent wound closure surgery alone. The “later group” included 145 wounds in 138 patients who underwent similar wound closure procedures with the addition of Achilles tendon–lengthening surgery.

Results: Twenty-five percent in the early group and 2 percent of patients in the later group developed recurrent ulceration requiring reoperation, which resulted in 94 percent relative risk reduction (p < 0.001), whereas the risk factors and demographic data were similar in each group. In addition, 12 percent in the early group and 4 percent of the later group developed transfer lesions (p < 0.001).

Conclusion: If one avoids excessive Achilles lengthening, the addition of an Achilles tendon–lengthening procedure can significantly reduce the risk of recurrent diabetic foot ulcerations.


Norfolk and Virginia Beach, Va.; and Taiwan, Republic of China

From Norfolk Plastic Surgery, the Department of General Surgery, Tidewater Foot & Ankle Center, and the Department of Epidemiology-Biostatistics, Eastern Virginia Medical School; and the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital.

Received for publication December 13, 2011; accepted July 30, 2012.

Presented at the 88th Annual Meeting of the American Association of Plastic Surgeons, in Rancho Mirage, California, March 21 through 25, 2009.

Disclosure:No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this study.

Lawrence B. Colen, M.D.; Eastern Virginia Medical School, Norfolk Plastic Surgery, 6261 East Virginia Beach Boulevard, Norfolk, Va. 23502,

©2013American Society of Plastic Surgeons