FHL Tendon Transfer in Diabetics for Treatment of Non-Healing Plantar Heel Ulcers

Abstract

Background: In diabetics, although heel ulcers occurring after Achilles tendon lengthening for managing forefoot ulcers are rare, they are a very troublesome complication. The purpose of this study was to evaluate the results of FHL tendon transfer for management of a plantar heel ulcer as a sequelae of insufficiency of the Achilles tendon in diabetic patients. Materials and Methods: Nine diabetic patients who underwent FHL tendon transfer for treatment of non-healing plantar heel ulcers due to insufficiency of the Achilles tendon for management of forefoot ulcers were treated between October 2005 and April 2007. All of the patients had undergone Achilles tendon lengthening with Hoke's triple hemisection method. The mean age was 55.9 ± 9.7 years old. The average duration of a plantar heel ulcer was 11.9 ± 3.8 months. The mean period of followup was 23.9 ± 8.0 months. Between the occurrence of a heel ulcer and the FHL transfer, five of the patients underwent more than one attempt at direct Achilles tendon repair. The mean size of the wound was 1.2 ± 0.6 cm2. We assessed the healing time of the heel plantar ulcers and recurrence rates during followup periods. The complication rate and walking ability was also evaluated. Results: All of the plantar heel ulcers healed within 8 weeks after the operation and had not recurred as of the last followup. Two patients had recurrences of previous forefoot ulcers. One patient had a local infection in the FHL tendon transfer area. All of patients could walk without a brace or walking aid device after surgery. Conclusion: We believe that Achilles tendon reconstruction using an FHL transfer for non healing plantar heel ulcers resulting from a triple Hoke lengthening of the Achilles tendon is a good treatment option for diabetic patients. Level of Evidence: IV, Retrospective Case Series