August 2012

Selective plantar fascia release assists healing of recalcitrant forefoot ulcers

In the moment: Footcare

By Emily Delzell

Korean surgeons have developed an alternative to Achilles tendon lengthening for reducing plantar pressure and promoting wound healing in patients with diabetic foot ulcers.

In the July issue of the Journal of Bone and Joint Surgery, the group reported on a simpler, less morbid procedure they’ve developed, selective plantar fascia release (SPFR), which involves transection of plantar fascia fibers that insert into the affected toe. The surgeons followed 60 patients with nonhealing diabetic forefoot ulcers who underwent SPFR for a mean of 23.5 months after surgery.

Fifty-six percent of ulcers healed in six weeks and the overall wound resolution rate was 67%; 100% of patients with an intact metatarsophalangeal (MTP) joint and a postoperative MTP range of motion between 5° and 30° achieved wound healing. Postoperative dorsiflexion increases of 13° or greater were also predictive of good outcomes. Patients experienced no complications or ulcer recurrence during follow up. By comparison, reported complications rates for Achilles tendon lengthening have ranged from 10% to 30%.

Kim JY, Hwang S, Lee Y. Selective plantar fascia release for nonhealing diabetic plantar ulcerations. J Bone Joint Surg Am 2012;94(14):1297-1302.

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