Concomitant Achilles Tendon Lengthening with Transmetatarsal Amputation for the Prevention of Late Forefoot Ulceration #ActAgainstAmputation #DiabeticFoot #Diabetes

This is an important addition to the literature from the pride of Saginaw, Bullock and coworkers. that is definitely worth a read. It follows on earlier work in JBJS from our team and the team from Washington University, St. Louis.


Late development of forefoot ulcers is a common finding after transmetatarsal amputation (TMA). The primary aim of this study was to examine whether concomitant prophylactic Achilles tendon lengthening (ATL) was associated with a reduction in the incidence of forefoot ulcers postoperatively.


A retrospective chart review was performed by 2 authors to identify patients who underwent TMA over a period of 5.5 years from January 1, 2015, through July 31, 2020. They identified 110 feet in 107 patients; the 83 patients (85 feet) who had ≥120 days of follow-up were used for the study. Follow-up was performed with telephone calls (80 patients) or during the last office visit (3 patients). Those who were contacted by telephone were asked if they developed an ulcer after healing from the original surgery. Mean follow-up time was 672 ± 258 days for the 30 feet with concomitant Achilles lengthening and 663 ± 434 days for the 55 feet without Achilles lengthening. Demographic data were analyzed for association with late development of forefoot ulceration.


Eighty-five feet were included in the analysis. Late forefoot ulcers developed in 35% of feet that had a TMA alone (n = 55) compared with 3% of feet who received a concomitant ATL (n = 30; p < 0.001); the 2 groups had similar mean follow-up times. Mean time to ulcer development was 587 ± 420 days in the 19 patients without Achilles lengthening. Of the patients who developed late forefoot ulcers, 47% also developed osteomyelitis, and 16% went on to proximal amputation. Patients who developed forefoot ulcers were younger (55 ± 12 versus 63 ± 11 years of age; p = 0.006) than those who did not.


ATL at the time of TMA is associated with a reduction in the risk of later development of forefoot ulcers, especially in younger patients.

One thought on “Concomitant Achilles Tendon Lengthening with Transmetatarsal Amputation for the Prevention of Late Forefoot Ulceration #ActAgainstAmputation #DiabeticFoot #Diabetes

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  1. It’s nice Work Dr, Bravo. Only, picture clearly shows us patient needs a treatment to make his skin fresh, flexible, with better cutaneous respiration, without danger of cracking. If the leg has this appearance, it means that the epithelia everywhere are packed with cell debrisand need relief to avoid the worst. Danger si still there but, It’s really a great success.

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