Resurrection of the Achilles tenotomy

This study evaluates the results of treating neuropathic diabetes mellitus (DM) foot ulcers with Achilles tendon percutaneous complete tenotomy. To the authors' knowledge this study is the largest of this nature to date. One hundred twenty-seven patients with Wagner Grade 1 to 4 foot ulcers were treated with percutaneous Achilles complete tenotomy between January 2007 and December 2010. All procedures were performed under local anesthesia and sedation in the operating room. The foot was held in maximum dorsiflexion, while the tendon was cut and completely released. The surgical site was dressed in a well-padded sterile dressing and wrap. Patients steadily increased their tolerance to walking in a post-op shoe. One hundred twenty-one patients who underwent percutaneous complete tenotomy experienced healing of their ulcers. To date, no Achilles contracture recurrences have been reported. Three patients experienced treatment-related adverse events. An additional six patients had recalcitrant ulcers requiring further therapy. Our findings in 127 patients with neuropathic diabetic foot ulcers add further credence to the growing evidence that percutaneous complete tenotomy of the Achilles tendon is a viable approach to treat Wagner Grade 1 to 4 foot ulcers.