title: Achilles tendon lengthening:  friend or foe in the diabetic foot?
abstract: 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).
  
  
  CONCLUSIONS
  If one avoids excessive Achilles lengthening, the addition of an Achilles tendon-lengthening procedure can significantly reduce the risk of recurrent diabetic foot ulcerations.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: 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.
authors.forename: Lawrence B
authors.initials: LB
authors.lastname: Colen
authors.forename: Claudia J
authors.initials: CJ
authors.lastname: Kim
authors.forename: William P
authors.initials: WP
authors.lastname: Grant
authors.forename: Jiun-Ting
authors.initials: JT
authors.lastname: Yeh
authors.forename: Baydoun
authors.initials: B
authors.lastname: Hind
mesh_terms: D000125:Achilles Tendon / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017719:Diabetic Foot / Q000517:prevention & control* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D019651:Plastic Surgery Procedures; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D055502:Secondary Prevention; D058971:Tenotomy; D016896:Treatment Outcome; D058106:Wound Closure Techniques