Houston Methodist. Leading Medicine

Foot FAQ

Question:

I have a diabetic foot ulcer that isn't responding to treatment. The team of diabetes experts at our clinic are recommending surgery to release the calf muscle where it attaches to the tendon. If I have this procedure, what kind of problems could I end up with? I don't want to trade one set of problems for another by having this operation.

Answer:

Studies show that surgically lengthening the gastrocnemius (calf) muscle in patients with diabetes helps heal foot ulcers. That discovery pointed out the association between abnormal foot positioning, altered biomechanics, and foot pain all linked to a tight calf muscle. Armed with that information, surgeons started taking a closer look at different patients with chronic, persistent foot pain. They tried lengthening the gastrocnemius muscle and found good outcomes with it. As a result, more studies have been done to look at the effect of gastrocnemius lengthening on the ankle joint, foot arch, position of the hindfoot, and joint range of motion. They recognized that an inflexible gastrocnemius muscle can pull so hard on the bones that it deforms the normal or natural shape of the foot and ankle. In someone with diabetes, the increased pressure on one area of the collapsed foot or foot with altered alignment can cause skin breakdown and eventually, skin ulcers. By releasing the gastrocnemius muscle and its tendon (the Achilles tendon, the foot and ankle can return to a more normal midline position. Release of pull on the bony structures makes it possible to restore normal arch shape, structure, and function. It has been suggested that arch collapse in its more advanced stages can't be restored without the gastrocnemius release procedure. There are a few downsides to the procedure. It can cause some calf weakness but this is only temporary. The gastrocnemius is a large muscle that can quickly recover with full return of strength. Damage to the sural nerve is also possible. The sural nerve goes through the gastrocnemius muscle down to the foot. One other risk with this surgery is an unsightly scar because it is done with an open incision. Be sure and ask your surgeon this same question. It's always good to speak with someone who knows your specific case and needs. John G. Anderson, et al. Treatment of Recalcitrant Foot Pain with Gastrocnemius Muscle Lengthening. In Current Orthopaedics Practice. May/June 2010. Vol. 21. No. 3. Pp. 251-257.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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