Midfoot Ulcers Treated with Gastrocnemius-Soleus Recession

Laborde, James Monroe

doi:10.3113/fai.2009.0842

Cited by 50 publications

(46 citation statements)

References 16 publications

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“…More recently, other techniques to relieve pressure have gained prominence, including gastrocnemius recession and tenotomy of the flexor digitorum longus, peroneus longus, and tibialis posterior. 20,22,23 Our study seems to demonstrate the impact of this line of research.…”

Section: Discussionsupporting

confidence: 56%

Declines in Lower Extremity Amputation in the US Medicare Population, 2000-2010

Belatti

Phisitkul

2013

Foot Ankle Int.

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Section: Discussionsupporting

confidence: 56%

Declines in Lower Extremity Amputation in the US Medicare Population, 2000-2010

Belatti

Phisitkul

2013

Foot Ankle Int.

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“…In another study, risk for heel ulcers was 15% at a median 12 months follow‐up that also showed that the highest risk for heel ulcers (47%) was in patients with heel anaesthesia and significant dorsiflexion that was possible after ATL; these conditions therefore imply a contraindication . Other studies report no or only a small risk of heel ulceration from ATL . Risk of transfer ulcers after single metatarsal head resection was 41% in an average 13.1 months in one study , while two other studies did not report any transfer ulcers from this procedure at either 6 or 12 months follow‐up .…”

Section: Surgical Offloading Interventionsmentioning

confidence: 94%

“…One RCT with low risk of bias and several non‐controlled studies show the positive effect of ATL, performed primarily to heal recalcitrant forefoot plantar ulcers, in preventing ulcer recurrence . Relative risk reductions over conservative treatment were 75% and 52% at 7 months and 2 years, respectively .…”

Section: Surgical Offloading Interventionsmentioning

confidence: 98%

IWGDF guidance on footwear and offloading interventions to prevent and heal foot ulcers in patients with diabetes

Bus

Armstrong

Deursen

et al. 2016

Diabetes Metabolism Res

175

196

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RecommendationsCasting and prefabricated healing devices 1. To heal a neuropathic plantar forefoot ulcer without ischemia or uncontrolled infection in a patient with diabetes, offload with a non-removable knee-high device with an appropriate foot-device interface. (GRADE strength of recommendation: strong, Quality of evidence: high) 2. When a non-removable knee-high device is contraindicated or not tolerated by the patient, consider offloading with a removable knee-high walker with an appropriate foot-device interface to heal a neuropathic plantar forefoot ulcer in a patient with diabetes, but only when the patient can be expected to be adherent to wearing the device. (Weak; Moderate) 3. When a knee-high device is contraindicated or cannot be tolerated by the patient, consider offloading with a forefoot offloading shoe, cast shoe, or custom-made temporary shoe to heal a neuropathic plantar forefoot ulcer in a patient with diabetes, but only when the patient can be expected to be adherent to wearing the shoes. (Weak; Low) Therapeutic footwear4. To protect their feet, instruct an at-risk patient with diabetes not to walk barefoot, in socks only, or in thin-soled standard slippers, whether at home or when outside. (Strong; Low) 5. Instruct an at-risk patient with diabetes to wear properly fitting footwear to prevent a first foot ulcer, either plantar or non-plantar, or a recurrent nonplantar ulcer. When a foot deformity or a pre-ulcerative sign is present, consider prescribing therapeutic shoes, custom-made insoles, or toe orthosis. (Strong; Low) 6. To prevent a recurrent plantar foot ulcer in an at-risk patient with diabetes, prescribe therapeutic footwear that has a demonstrated plantar pressurerelieving effect during walking (i.e. 30% relief compared with plantar pressure in standard of care therapeutic footwear) and encourage the patient to wear this footwear. (Strong; Moderate) 7. Do not prescribe, and instruct a patient with diabetes not to use, conventional or standard therapeutic shoes to heal a plantar foot ulcer. (Strong; Low) 8. Consider using shoe modifications, temporary footwear, toe spacers, or

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“…A gastrocnemius recession may be used as an alternative for relief of forefoot pressure 60 and has also been described as an effective treatment for midfoot ulcers (Fig 11). 60,61 …”

Section: Tal Lengtheningmentioning

confidence: 98%

Surgical off-loading of the diabetic foot

Frykberg

Bevilacqua

Habershaw

2010

Journal of Vascular Surgery

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Surgical intervention for chronic deformities and ulcerations has become an important component in the management of patients with diabetes mellitus. These patients are no longer relegated to wearing cumbersome braces or footwear for deformities that might otherwise be easily corrected. Although surgical intervention in these often high-risk individuals is not without risk, the outcomes are fairly predictable when patients are properly selected and evaluated. In this brief review, we discuss the rationale and indications for diabetic foot surgery, focusing on the surgical decompression of deformities that frequently lead to foot ulcers.

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Midfoot Ulcers Treated with Gastrocnemius-Soleus Recession

Abstract: The author believes gastrocnemius-soleus recession as a primary treatment of diabetic midfoot ulcers is a low risk method of promoting ulcer resolution.

Cited by 50 publications

References 16 publications

Declines in Lower Extremity Amputation in the US Medicare Population, 2000-2010

Declines in Lower Extremity Amputation in the US Medicare Population, 2000-2010

IWGDF guidance on footwear and offloading interventions to prevent and heal foot ulcers in patients with diabetes

Surgical off-loading of the diabetic foot

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