Cath Lab Digest

   The 7 percent (5/75) amputation rate in this study is less than the 16 percent (75/468) amputation rate that Apelqvist and co-workers reported in another study three years after ulcers healed after non-operative treatment.²⁹ All amputations in this study were from gangrene due to arterial insufficiency. None of the amputations were due to ulcer infection. This amputation rate is much less than the 84 percent (67/80) amputation rate secondary to foot ulcers reported by Pecararo and colleagues.¹ This is consistent with a reduced amputation rate after tendon lengthening.

   Tendon lengthening may also prevent the progression of Charcot arthropathy.¹⁵ Another study with more patients and longer follow-up is underway to further evaluate this possibility.

   Tendon lengthening is my first choice for the treatment of diabetic and other causes of ulcers plantar to the toe, metatarsal head and midfoot.^2-15

In Conclusion

This study suggests that tendon lengthening is an effective treatment for plantar foot ulcers. The results of this study compare favorably with the published results of other operative and non-operative treatments for forefoot and midfoot ulcers. Tendon lengthening heals more ulcers with much less recurrence and less complications than the reported results of other treatments I have discussed above.

   Dr. Laborde is an Orthopaedic Surgeon at Touro Infirmary. He is a Clinical Assistant Professor of Orthopaedic Surgery at the Tulane University School of Medicine at Louisiana State University Health Sciences Center in New Orleans, La. and is director of Foot Clinic at LSUHSC.