Functional and Limb Salvage Outcomes after Excision of Infected Achilles Tendon in Diabetic Patients; a Comarative Prospective Study

Abstract

Background: Infected Achilles tendon is difficult to manage especially in diabetic patients. Total excision of the infected tendon may provide better option for limb salvage in these patients where altered walking pattern can minimize expected subsequent functional impairment.Patients and methods: 35 diabetics with infected Achilles tendon were enrolled in this study. Nineteen patients underwent complete tendon excision (Group A) while in the remaining 16 patients, the tendon was partially excised (Group B). After wound approximation, negative pressure was applied to achieve healing by secondary intention. Initial immobilization and splinting were done followed by gradual weight bearing. Heel-rise test, activity limitation, walking difficulty on different surfaces and gait abnormalities were used to assess functional outcome.Results: Group A had significantly larger ulcer size compared to Group B (9.23 ± 2.04 vs 7.35 ± 3.30 cm2, P = 0.05). Also, mean ulcer duration was significantly longer in Group A (2.53 ± 0.75 vs 1.09 ± 0.49 months, P < 0.001). Group A showed significantly shorter healing time (3.14 ± 0.79 vs 7.05 ± 1.56 months, P < 0.001), shorter follow-up period (5.32 ± 1.6 vs 8.25 ± 2.94 months, P = 0.001) and lower reintervention rate (5.26% vs 56.25%, P < 0.001) compared to Group B. Functional assessment showed more limitation in heel-rise in total excision group, yet without significant limitation in other functional parameters, including walking ability. Conclusion:Total excision of infected Achilles tendon in diabetic patients can give higher healing success rates with minimal functional impairment compared to partial tendon excision.