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The prevalence of non-healing diabetic foot ulcers in increasing and its management continues to be a challenge with high rates of progression and recurrence. The Achilles tendon in diabetics undergoes microscopic reorganization leading to its shortening. The resulting equinus deformity, combined with neuropathy and arthropathy, may cause pressure ulcers to form on the plantar aspect of the forefoot. Without ofoading the pressure at these points, the lesions remain open. Lengthening of the Achilles tendon restores normal range of motion of the ankle and decreases pressure facilitating ulcer healing. This short, same day procedure, done under local anaesthesia allows immediate extension of the tendon. Fourteen patients with non-healing ulcers had tenotomies. Ankle dorsiexion before and after was documented and time taken for the ulcers to heal post operatively recorded. All patients showed immediate improvement in the amount of ankle extension postoperatively; ulcer healing was achieved on average by 8 weeks. One patient has recurrence of ulceration at 15 months postoperatively. Follow up time was 18 months. Achilles tendon lengthening is an easy, safe, same day procedure for diabetic patients and should be considered as an option for non-healing pressure ulcers to the soles of their feet.

Traditional anatomic textbooks suggest that the recurrent laryngeal nerve (RLN) ascends in the tracheoesophageal groove (TEG). However, during thyroid and parathyroid surgery, we have noted that the RLN is often not in the groove. In this study, we objectively measured the course of 41 RLNs in relation to the TEG. We found that the RLN was in the groove in only one case. On the right, the angle ranged from 0 – 50°(mean 27.5°) and on the left the range was 15 – 45°, (mean 25.5°) away from the TEG. In conclusion, it was unusual for the RLN to lie in the tracheo-esophageal groove. Thus, in mobilizing the thyroid lobe medially during thyroidectomy, one must exercise care as it is likely that one will encounter the RLN well lateral to the groove. We propose a new technique of objectively measuring the deviation of the RLN from the TEG.