to the editor: This article is an excellent review of antibiotic treatment of foot infections. Dr. Bader correctly states that most diabetic foot infections develop because of a foot ulcer, and that decreasing pressure in the ulcer area is crucial to healing the ulcer and the infection. However, there are newer and more successful surgical treatments that were not mentioned in the article.Tendon lengthening has been shown to decrease pressure in the forefoot, where most ulcers are located. One study examined ulcers that did not heal with use of a total contact cast and were treated with Achilles tendon lengthening (ATL); 93 percent healed and did not recur. Results of a randomized controlled study demonstrated that the healing rate after ATL combined with treatment in a total contact cast was higher than that associated with treatment with a total contact cast alone. The recurrence rate at two years after ulcer healing was 81 percent in patients treated with a total contact cast alone compared with 38 percent in those treated with a total contact cast and ATL. These two studies demonstrated the superiority of tendon lengthening over management with a total contact cast in terms of the rate of healing and especially the rate of recurrence of ulcers.
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