Achilles Tendon Surgery Helps Prevent Diabetic Foot Ulcers

Diabetic patients frustrated by hard-to-heal, infection-prone ulcers on their feet could benefit from a common, minimally invasive surgical procedure to relieve tightness in their Achilles tendons.

The Achilles is the largest tendon in the human body, connecting the calf muscles to the heel bone. As we age, the tendon naturally tightens. However, diabetes exacerbates the process as increased blood sugar levels deposit glucose in the collagen of the tendon, greatly reducing its elasticity and making stretching almost impossible.

"A tight Achilles inhibits ankle movement, forcing diabetic patients to place excessive pressure on the front of the foot," said Dr. Alap Shah, specializing in diabetes and diabetic wound care here at Foot and Ankle of West GA. "Pressure normally absorbed by the ankle has to go somewhere else and the forefoot gets most of it, heightening the risk for ulcer development underneath the toe joints."

Foot sores or ulcers are a common complication of diabetes. They result from sensation loss or neuropathy, which deprives diabetes patients of their ability to feel pressure or pain in the lower extremities. Therefore, according to Dr. Shah, even the slightest cut, blister or wound can develop into a diabetic foot ulcer. Such wounds can cause tissue and bone infections and can result in loss of a toe, a foot, a leg or even a life.

Published research has shown that surgery to lengthen the Achilles tendon in a diabetes patient can help prevent ulcer recurrence. "Our goal always is to close the wound as quickly as possible to avoid infection, and we’re becoming more aware that preventing ulcer recurrence in patients with advanced diabetes is best achieved by a minimally invasive procedure to lengthen a tight Achilles tendon," Dr. Shah said.

Lengthening occurs by making three small, pinpoint cuts to loosen and stretch the tendon. This helps restore ankle flexibility and relieves forefoot pressure. The procedure allows diabetes patients who keep their blood sugar under control to walk more normally and may lower their risk for redeveloping foot ulcers.

"I have seen diabetic patients whose foot ulcers heal, yet continue to recur because the untreated Achilles tendon problem is the root cause," said Dr. Shah. He advises diabetic patients who have developed foot ulcers to schedule an appointment with him at the office to determine if Achilles tendons surgery is appropriate for them.