Gastrocnemius fascia release under local anaesthesia as a treatment for neuropathic foot ulcers in diabetic patients: a short series

Bael, Kobe Van; Tempel, G; Claus, Isabelle; Speybrouck, Sabrina; Coster, Johan De; Laere, Sylvie De; Debing, Erik; Aerden, Dimitri

doi:10.1080/00015458.2016.1192378

Cited by 7 publications

(2 citation statements)

References 12 publications

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“…Furthermore, the correlation between the years of diabetes and CF US thickness of the poster region of the leg, respectively, for Post 1 (r = 0.3875, p = 0.0344), for Post 2 (r = 0.5089, p = 0.0041) (Table 10 and Figure 3), and between Post 2 and NDS (r = 0.5779, p = 0.0008), could be explained by the fact that the proximal progression of diabetes leads to involvement of CF and the latter becomes densified/fibrotic, consequently increasing its thickness [25] and altering their proprioception, with fascia richly innervated [53]. These observations could be confirmed surgically by the effectiveness of release intervention at the level of the myotendinous junction of the medial gastrocnemius [54], which could work on two fronts: (1) to reduce the tension on the Achilles tendon; (2) to hold CF, not foreseeing the surgical incision of the latter. The results have also confirmed, as has been demonstrated by other previous studies [22,23], that PF US thickness has increased in diabetic patients at calcaneal insertion; while no study studied it at the level of the middle third of the sole of the foot, this study for the first time demonstrated that also at this level there is an increase in the PF thickness, confirming that diabetes affects the whole plantar fascia and fasciae [25].…”

Section: Discussionmentioning

confidence: 76%

Crural and Plantar Fasciae Changes in Chronic Charcot Diabetic Foot: A Cross-Sectional Ultrasound Imaging Study—An Evidence of Fascial Continuity

Pirri

Biz

Pirri

et al. 2023

JCM

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Crural fascia (CF) and plantar fascia (PF) are biomechanically crucial in the gait and in the proprioception, particularly in the propulsion phase of the foot during the gait cycle and in the dissipation of forces during weight-bearing activities. Recent studies have revealed an association between increases in PF thickness and diabetes. The purpose of this study was to measure and compare by ultrasound (US) imaging the thickness of the CF and PF at different regions/levels in chronic Charcot diabetic foot patients (group 1) and in healthy volunteers (group 2). A cross-sectional study was performed using US imaging to measure the CF with Pirri et al.’s protocol and PF with a new protocol in a sample of 31 subjects (15 patients and 16 healthy participants). The findings for CF and PF revealed statistically significant differences in the poster region of CF (Post 1: group 1 vs. group 2: p = 0.03; Post 2: group 1 vs. group 2: p = 0.03) and in PF at two different levels (PF level 1: group 1 vs. group 2: p < 0.0001; PF level 2: group 1 vs. group 2: p < 0.0001). These findings suggest that chronic Charcot diabetic foot patients have CF and PF thicker compared to healthy volunteers. The US examination suggests that fascial thicknesses behavior in these patients points out altered fascial remodeling due to diabetes pathology and biomechanical changes.

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Section: Discussionmentioning

confidence: 76%

Crural and Plantar Fasciae Changes in Chronic Charcot Diabetic Foot: A Cross-Sectional Ultrasound Imaging Study—An Evidence of Fascial Continuity

Pirri

Biz

Pirri

et al. 2023

JCM

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“…Specifically, thickening and increased tendon stiffness of the Achilles tendon restrict ankle dorsiflexion range of motion. [14][15][16]19,20,46,47 During tasks like walking, restricted ankle dorsiflexion alters foot mechanics and changes plantar pressure on the foot. 15,[17][18][19] Giacommozzi and colleagues have reported a combination of plantar fascia thickness, Achilles tendon thickness, and great toe extension to account for 70.1% of the total variance in vertical force through the metatarsals during walking gait.…”

Section: Clinical Manifestations Of Diabetes On Tendon Homeostasis An...mentioning

confidence: 99%

Effect of Diabetes on Tendon Structure and Function: Not Limited to Collagen Crosslinking

Vaidya

Lake

Zellers

2022

J Diabetes Sci Technol

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Diabetes mellitus (DM) is associated with musculoskeletal complications—including tendon dysfunction and injury. Patients with DM show altered foot and ankle mechanics that have been attributed to tendon dysfunction as well as impaired recovery post-tendon injury. Despite the problem of DM-related tendon complications, treatment guidelines specific to this population of individuals are lacking. DM impairs tendon structure, function, and healing capacity in tendons throughout the body, but the Achilles tendon is of particular concern and most studied in the diabetic foot. At macroscopic levels, asymptomatic, diabetic Achilles tendons may show morphological abnormalities such as thickening, collagen disorganization, and/or calcific changes at the tendon enthesis. At smaller length scales, DM affects collagen sliding and discrete plasticity due to glycation of collagen. However, how these alterations translate to mechanical deficits observed at larger length scales is an area of continued investigation. In addition to dysfunction of the extracellular matrix, tendon cells such as tenocytes and tendon stem/progenitor cells show significant abnormalities in proliferation, apoptosis, and remodeling capacity in the presence of hyperglycemia and advanced glycation end-products, thus contributing to the disruption of tendon homeostasis and healing. Improving our understanding of the effects of DM on tendons—from molecular pathways to patients—will progress toward targeted therapies in this group at high risk of foot and ankle morbidity.

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Der diabetische Fuß

Debus¹,

Grundmann²

2018

Evidenzbasierte Chirurgie

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Gastrocnemius fascia release under local anaesthesia as a treatment for neuropathic foot ulcers in diabetic patients: a short series

Abstract: Gastrocnemius fascia release under local anaesthesia can be performed safely in diabetic patients with plantar neuropathic ulcers under the metatarsal heads. Clinical outcome is excellent and long-term results promising.

Cited by 7 publications

References 12 publications

Crural and Plantar Fasciae Changes in Chronic Charcot Diabetic Foot: A Cross-Sectional Ultrasound Imaging Study—An Evidence of Fascial Continuity

Crural and Plantar Fasciae Changes in Chronic Charcot Diabetic Foot: A Cross-Sectional Ultrasound Imaging Study—An Evidence of Fascial Continuity

Effect of Diabetes on Tendon Structure and Function: Not Limited to Collagen Crosslinking

Der diabetische Fuß

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