title: Effects of a tendo-Achilles lengthening procedure on muscle function and gait characteristics in a patient with diabetes mellitus.
abstract: METHODS
  Case report with repeated measures.
  
  
  OBJECTIVE
  To describe the effects of a tendo-Achilles lengthening (TAL) and total contact casting (TCC) on wound healing, motion, plantar pressure, and function in a patient with diabetes mellitus, peripheral neuropathy, neuropathic ulcer, and limited dorsiflexion range of motion (DFROM).
  
  
  BACKGROUND
  Limited DFROM has been associated with increased forefoot pressures and skin breakdown. A TAL was expected to increase DFROM and reduce forefoot pressures during walking, but the influence on muscle performance and function was unknown.
  
  
  METHODS
  The patient was a 42-year-old man with a 20-year history of type 1 diabetes (NIDDM) and a recurrent neuropathic plantar ulcer. Outcome measures were DFROM, isokinetic plantar flexor muscle peak torque, in-shoe and barefoot peak plantar pressure, physical performance test (PPT) score, and peak ankle and hip moments during walking obtained from an automated gait analysis. All tests were completed pre-TAL, 8 weeks post-TAL (after immobilization in a TCC), and 7 months post-TAL.
  
  
  RESULTS
  The wound healed in 40 days. The TAL resulted in a sustained increase in DFROM (0 to 18 degrees). Plantar flexor peak torque was reduced by 21% 8 weeks after the TAL compared with the torque before surgery but recovered fully at 7 months. Seven months following TAL, in-shoe forefoot peak plantar 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.
  
  
  CONCLUSIONS
  For this patient, a TAL resulted in short-term deficits in peak plantar flexor torque, but a 7-month follow-up showed improvements in ankle DFROM, walking ability, and a decrease in forefoot in-shoe peak plantar pressure.
authors.affiliation: Washington University, School of Medicine, Program in Physical Therapy, St Louis, Mo. 63108-2212, USA. HastingM@medicine.wustl.edu
authors.forename: M K
authors.initials: MK
authors.lastname: Hastings
authors.forename: M J
authors.initials: MJ
authors.lastname: Mueller
authors.forename: D R
authors.initials: DR
authors.lastname: Sinacore
authors.forename: G B
authors.initials: GB
authors.lastname: Salsich
authors.forename: J R
authors.initials: JR
authors.lastname: Engsberg
authors.forename: J E
authors.initials: JE
authors.lastname: Johnson
mesh_terms: D000125:Achilles Tendon / Q000601:surgery*; D000328:Adult; D002370:Casts, Surgical; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D017719:Diabetic Foot / Q000503:physiopathology / Q000601:surgery*; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000502:physiology*; D009989:Orthotic Devices; D011312:Pressure; D016059:Range of Motion, Articular; D012008:Recurrence; D019415:Torque; D014945:Wound Healing / Q000502:physiology