Gastrocnemius Fascia Release under Local Anaesthesia as a Treatment for Neuropathic Foot Ulcers in Diabetic Patients: a short series

BACKGROUND: Diabetic foot ulceration is the leading cause of major amputation in the developed world. Plantar neuropathic ulcers at the forefoot can be managed conservatively with off-loading but treatment is not invariably successful. Achilles-tendon lengthening procedures aim at increasing dorsiflexion and decreasing forefoot pressure, but can be associated with complications and require prolonged postoperative immobilization to prevent tendon rupture. We assessed the feasibility and clinical outcome of a comparative minimal invasive procedure: the gastrocnemius fascia release. This technique targets the same goals but is performed under local anesthesia and allows immediate postoperative weight-bearing and ambulation.

METHODS: Diabetic patients with plantar neuropathic ulcers Wagner grade 2 or 3 were recruited from our diabetic foot clinic. Patients with infected wounds or untreatable peripheral arterial disease were excluded from the study. Conservative treatment with off-loading and local wound care was attempted for six weeks and surgical procedure only contemplated upon failure. Primary end-points were improved range of dorsiflexion and time-to-healing. Secondary end-points were local ulcer recurrences, new plantar ulcers and minor or major amputation. Postoperative follow-up was 12 months.

RESULTS: 7 patients were included in the study. An improvement in dorsiflexion of 10.4° (mean) was recorded postoperatively (p < 0.01). After 30 days, complete healing was accomplished in 6 of the 7 patients. Long-term results were excellent as no ulcer recurrence or amputation was noted.

CONCLUSIONS: Gastrocnemius fascia release under local anaesthesia can be performed safely in diabetic patients with plantar neuropathic ulcers under the metatarsal heads. Clinical outcome is excellent and long-term results promising.