Effects of a tendo-Achilles lengthening procedure on muscle function and gait characteristics in a patient with diabetes mellitus

Study Design: Case report with repeated measures. Objectives: To describe the effects of a tendo-Achilles lengthening (TAL) a nd total contact casting (TCC) on wound healing, motion, plantar pressure, and function in a patient with diabetes mellitus, peripheral neuropathy, ne uropathic ulcer, and limited dorsiflexion range of motion (DFROM). Background: Limited DFROM has been associated with increased forefoot press ures and skin breakdown. A TAL was expected to increase DFROM and reduce fo refoot pressures during walking, but the influence on muscle performance an d function was unknown. Methods and Measures: The patient was a 42-year-old man with a 20-year hist ory of type 1 diabetes (NIDDM) and a recurrent neuropathic plantar ulcer. O utcome measures were DFROM, isokinetic plantar flexor muscle peak torque, i n-shoe and barefoot peak plantar pressure, physical performance rest (PPT) score, and peak ankle and hip moments during walking obtained from an autom ated gait analysis. Ail tests were completed pre-TAL, 8 weeks post-TAL (aft er immobilization in a TCC), and 7 months post-TAL. Results: The wound healed in 40 days. The TAL resulted in a sustained incre ase in DFROM (0 to 18 degrees). Plantar flexor peak torque was reduced by 2 1% 8 weeks after the TAL compared with the torque before surgery but recove red fully at 7 months. Seven months following TAL, in-shoe forefoot peak pl antar pressure was reduced by 55%, barefoot pressure decreased by 14%, PPT score increased by 24%, peak ankle plantar flexor moment remained decreased by 30%, and the peak hip flexor moment increased by 41% during walking. Conclusion: For this patient, a TAL resulted in short-term deficits in peak plantar flexor torque, but a 7-month follow-up showed improvements in ankl e DFROM, walking ability, and a decrease in forefoot in-shoe peak plantar p ressure.