Surgery to Prevent Diabetic Foot Ulcers

A common, minimally invasive procedure could relieve tightness in the Achilles tendon and help prevent ulcer recurrence in diabetic patients, according to a report from the American College of Foot and Ankle Surgeons (ACFAS, Chicago, IL, USA).

The largest tendon in the body, the Achilles, connects the calf muscles to the heel bone. As people age, the tendon naturally tightens. Then diabetes exacerbates the process, as increased blood sugar levels deposit glucose in the collagen of the tendon, reducing its elasticity and making stretching almost impossible.

Foot ulcers are a common complication of diabetes, resulting from neuropathy, which deprives diabetes patients of the ability to feel pressure or pain in the lower extremities.
Any cut, blister, or wound can develop into a diabetic foot ulcer. These wounds can cause tissue and bone infections and can also result in loss of a toe, a foot, or a leg.

"A tight Achilles inhibits ankle movement, forcing diabetic patients to place excessive pressure on the front of the foot,” explained J. Christopher Moore, D.P.M., a foot and ankle surgeon in Ashville (NC, USA). "Pressure normally absorbed by the ankle has to go somewhere else and the forefoot gets most of it, heightening the risk for ulcer development underneath the toe joints.”

According to Dr. Moore, research has shown that surgery to lengthen the Achilles tendon in a diabetes patient can help prevent ulcer recurrence. Lengthening is accomplished by making three small, pinpoint cuts to loosen and stretch the tendon. This helps restore ankle flexibility and relieves forefoot pressure. The procedure allows diabetes patients who keep their blood sugar under control to walk more normally and may lower their risk for redeveloping foot ulcers.