title: Heel overload associated with heel cord insufficiency.
abstract: BACKGROUND
  Heel cord lengthening is a common component of foot and ankle surgery. If the tendon is anatomically or functionally over lengthened patients may develop plantarflexion weakness and heel overload problems such as symptomatic plantar heel callosities and heel ulceration.
  
  
  METHODS
  Nine patients who developed heel overload or heel ulcer after a heel cord lengthening or an irreparable rupture were identified. Initial foot injury, risk factors, treatment, and followup were reviewed.
  
  
  RESULTS
  Five of the nine patients had diabetes and an insensate heel. The ulcer healed in two of five patients with a dorsiflexion stop brace, two with a tendon transfer, and one required a below knee amputation. There were four patients with heel overload with normal sensation and no diabetes. One improved with strengthening exercises, two with tendon transfer, and one required a below knee amputation.
  
  
  CONCLUSIONS
  Heel cord insufficiency can lead to an overload callus or a heel ulcer. Patients with diabetes and an insensate heel are at highest risk, but this problem also can occur in patients with normal sensation. Obesity and ipsilateral first toe amputation also may be risk factors.
authors.affiliation: Michigan International Foot and Ankle Center, 44555 Woodward Ave., Suite 105, Pontiac, MI 48341, USA. pegchilvers@hotmail.com
authors.forename: Margaret
authors.initials: M
authors.lastname: Chilvers
authors.forename: Eric S
authors.initials: ES
authors.lastname: Malicky
authors.forename: John G
authors.initials: JG
authors.lastname: Anderson
authors.forename: Donald R
authors.initials: DR
authors.lastname: Bohay
authors.forename: Arthur
authors.initials: A
authors.lastname: Manoli
mesh_terms: D000125:Achilles Tendon / Q000503:physiopathology* / Q000601:surgery; D000368:Aged; D017719:Diabetic Foot / Q000150:complications; D005260:Female; D006365:Heel / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology