Dallimore SM, Kaminski MR, et al.
Journal of foot and ankle research. Date of publication 2015 Jul 30;volume 8():33.
1. J Foot Ankle Res. 2015 Jul 30;8:33. doi: 10.1186/s13047-015-0085-6. eCollection
2015.
Tendon lengthening and fascia release for healing and preventing diabetic foot
ulcers: a systematic review and meta-analysis.
Dallimore SM(1), Kaminski MR(2).
Author information:
(1)Eastern Health Podiatry Department, Maroondah Hospital, Davey Drive, Ringwood
East, VIC 3135 Australia.
(2)Eastern Health Podiatry Department, Angliss Hospital, Albert Street, Upper
Ferntree Gully, VIC 3156 Australia.
BACKGROUND: Diabetic foot ulcers have a devastating impact on an individual's
health-related quality of life and functional status. Additionally, diabetic foot
ulcers impose a significant economic burden on our health care systems as a
result of complications such as infection, hospitalisation and amputation. The
current gold standard treatment for diabetic foot ulcers is total contact
casting. However, the rate of ulcer recurrence is high, indicating the need for
more effective long-term treatment options. Therefore, the aim of this study was
to systematically identify, critique and evaluate all literature investigating
the effectiveness of Achilles tendon lengthening, gastrocnemius recession and
selective plantar fascia release in healing and preventing diabetic foot ulcers.
REVIEW: Searches were conducted in MEDLINE, CINAHL, AMED, EMBASE and The Cochrane
Library from the earliest available date to November 2014. Methodological quality
of included studies was assessed using the Downs and Black checklist. Data from
randomised-controlled trials were analysed using random effects meta-analysis.
For all other studies, data were analysed descriptively. Eleven studies (614
participants) were included in the review, with a median sample size of 29
participants. Meta-analysis of two randomised-controlled trials found that there
was no statistically significant difference between Achilles tendon lengthening
or gastrocnemius recession and total contact casting for time to healing of
diabetic foot ulcers (mean difference, MD, 8.22 days; 95 % CI, -18.99 to 35.43;
P = 0.55; I (2) = 34 %) and the rate of ulcers healed (risk ratio, RR, 1.06;
95 % CI, 0.94 to 1.20; P = 0.34; I (2) = 41 %). The rate of ulcer recurrence was
significantly lower following Achilles tendon lengthening or gastrocnemius
recession than total contact casting (RR, 0.45; 95 % CI, 0.28 to 0.72; P < 0.001;
I (2) = 0 %).
CONCLUSIONS: Achilles tendon lengthening and gastrocnemius recession appear to be
effective surgical treatments for healing diabetic foot ulcers. The rate of ulcer
recurrence was lower following Achilles tendon lengthening or gastrocnemius
recession procedures compared to total contact casting treatment alone.
Therefore, these surgical procedures may provide viable treatment options for the
management and prevention of diabetic foot ulcers. Further rigorous
randomised-controlled trials with longer follow-up are required to determine the
long-term effectiveness and safety of these procedures.
DOI: 10.1186/s13047-015-0085-6
PMCID: PMC4546251
PMID: 26300980
