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Heel overload associated with heel cord insufficiency
Margaret Chilvers1, Eric S Malicky, John G Anderson
1Michigan International Foot and Ankle Center, 44555 Woodward Ave., Suite 105, Pontiac, MI 48341, USA. pegchilvers@hotmail.com
Foot & Ankle International
|June 27, 2007
Summary
Overlengthened heel cords can cause plantarflexion weakness, leading to heel overload or ulcers. Diabetic patients with insensate heels face the highest risk, but others can also be affected.
Area of Science:
- Orthopedic Surgery
- Podiatric Medicine
- Biomechanics
Background:
- Heel cord lengthening is a frequent procedure in foot and ankle surgery.
- Overlengthening of the Achilles tendon can result in functional deficits and complications like heel overload, callosities, or ulceration.
Purpose of the Study:
- To review cases of heel overload or ulceration following heel cord lengthening or irreparable rupture.
- To identify risk factors and evaluate treatment outcomes for these complications.
Main Methods:
- Retrospective review of nine patients with heel overload or heel ulcer post-heel cord surgery or rupture.
- Analysis of initial foot injury, patient risk factors, interventions, and follow-up data.
Main Results:
- Five patients had diabetes and insensate heels; two ulcers healed with bracing, two with tendon transfer, and one required amputation.
- Four patients without diabetes and with normal sensation experienced heel overload; one improved with exercises, two with tendon transfer, and one required amputation.
Conclusions:
- Heel cord insufficiency can precipitate heel overload calluses or ulcers.
- Patients with diabetes and insensate heels are at elevated risk, though complications can occur in patients with normal sensation.
- Obesity and first toe amputation may also be contributing risk factors.
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