Heel overload associated with heel cord insufficiency

Margaret Chilvers, Eric S. Malicky, John G. Anderson, Donald R. Bohay, Arthur Manoli

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Background: Heel cord lengthening is a common component of foot and ankle surgery. If the tendon is anatomically or functionally over lengthened patients may develop plantarflexion weakness and heel overload problems such as symptomatic plantar heel callosities and heel ulceration. Methods: Nine patients who developed heel overload or heel ulcer after a heel cord lengthening or an irreparable rupture were identified. Initial foot injury, risk factors, treatment, and followup were reviewed. Results: Five of the nine patients had diabetes and an insensate heel. The ulcer healed in two of five patients with a dorsiflexion stop brace, two with a tendon transfer, and one required a below knee amputation. There were four patients with heel overload with normal sensation and no diabetes. One improved with strengthening exercises, two with tendon transfer, and one required a below knee amputation. Conclusions: Heel cord insufficiency can lead to an overload callus or a heel ulcer. Patients with diabetes and an insensate heel are at highest risk, but this problem also can occur in patients with normal sensation. Obesity and ipsilateral first toe amputation also may be risk factors.

Original languageEnglish (US)
Pages (from-to)687-689
Number of pages3
JournalFoot and Ankle International
Issue number6
StatePublished - Jun 2007
Externally publishedYes


  • Achilles tendon
  • Diabetic foot
  • Heel ulcer

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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