Percutaneous lengthening of Achilles tendon

A 55-year-old African-American male with poorly controlled type 2 diabetes (HbA]c = 10.6%) of 8 years' duration, and dense peripheral neuropathy was seen regularly in the diabetic foot clinic for treatment of a chronic nonhealing full-thickness ulcer located beneath the 2nd and 3rd metatarsal heads of his left foot. The ulcer did not probe to bone. Treatment consisted of surgical wound debridement, total-contact casting, walking brace and a variety of topical wound healing agents.

Diagnostic studies

• Serial X-rays were negative for osteomyelitis: however, they revealed a long 3rd metatarsal

• MRI was unremarkable

• Non-invasive vascular studies were normal with evidence of strong pedal pulses

• EMED plantar pressure measurements revealed markedly elevated peak plantar pressure, 117N/cm2, located beneath the 2nd to 3rd metatarsal heads, right foot

• Arthrometric evaluation revealed ankle joint dorsiflex-ion was -6° with the knee extended, -2° with the knee flexed on the right ankle.

The proposed treatment for this patient was a percutaneous lengthening of the right Achilles tendon, by triple hemisection, under local anaesthesia. The patient consented to this minimally invasive procedure. Within 3-4 weeks the plantar ulcer was completely healed and has remained healed for the last 3 years. Peak pressure at the site of ulcer was significantly reduced to 42 N/cm2. The surgical technique is described below.

Peripheral Neuropathy Natural Treatment Options

Peripheral Neuropathy Natural Treatment Options

This guide will help millions of people understand this condition so that they can take control of their lives and make informed decisions. The ebook covers information on a vast number of different types of neuropathy. In addition, it will be a useful resource for their families, caregivers, and health care providers.

Get My Free Ebook

Post a comment