Time to Recurrence of Plantar Foot Ulceration in Patients Undergoing Percutaneous Tendo-Achilles Lengthening

Background: Equinus contracture is a common affliction in patients with diabetic foot ulceration. Percutaneous tendo-Achilles lengthening (TAL) is a useful method to alleviate peak plantar pressure and has been shown to reduce risk of ulcer recurrence. An estimated time to contracture recurrence has not been established.

Purpose: In this study, we aim to evaluate the effectiveness of percutaneous TAL and its longevity in preventing ulcer recurrence.

Methods: The medical records of patients with equinus contracture who underwent percutaneous TAL from 2010-2017 were retrospectively reviewed. Outcome measures included time to wound healing, time to ulcer recurrence, and development of transfer lesion.

Results: 91 patients were identified who underwent percutaneous TAL. 64 (70.3%) patients had a plantar forefoot ulcer, 6 (6.6%) had midfoot ulcers, 5 (5.5%) had hindfoot ulcers, and 3 (3.3%) had ulcers in multiple locations. 13 patients received prophylactic TAL. At a mean follow up of 30.6 months (±26mo), 51 (65%) wounds healed at a median 12.8 weeks. 36 patients (71%) experienced ulcer recurrence at a mean of 11 months. 13 patients (14%) experienced a transfer lesion at a mean of 15 months. 

Conclusions: Our data show that percutaneous TAL is useful as an adjunctive measure to achieve wound healing. Patients may require a re-lengthening procedure within approximately 1 year from index surgery.