title: Effect of Achilles tendon lengthening on ankle muscle performance in people with diabetes mellitus and a neuropathic plantar ulcer.
abstract: OBJECTIVE
  The effect of a tendo-Achilles lengthening (TAL) procedure on ankle muscle performance has not been clearly established. The purpose of this study was to compare the effects of TAL and total-contact casting (TCC) with TCC alone on ankle muscle performance in subjects with diabetes mellitus (DM) and a neuropathic plantar ulcer.
  
  
  METHODS
  Subjects were randomly assigned to either a TAL group (3 female and 12 male subjects) or a TCC group (4 female and 10 male subjects).
  
  
  METHODS
  Muscle performance measurements were obtained using an isokinetic dynamometer.
  
  
  RESULTS
  Concentric plantar-flexor peak torque decreased 31% after TAL but returned to the baseline level after 8 months. Dorsiflexor peak torque did not change in either group. Plantar-flexor passive torque at 0 degrees of dorsiflexion decreased after TAL but increased to 60% of the baseline level after 8 months. Maximal dorsiflexion angle increased 11 degrees after TAL and remained increased at 8 months.
  
  
  CONCLUSIONS
  The TAL resulted in an increase in ankle dorsiflexion range of motion and a temporary reduction in concentric plantar-flexor peak torque and passive torque at 0 degrees of dorsiflexion. If TAL is being considered for people with DM and a neuropathic forefoot ulcer, the initial compromise in plantar-flexor muscle performance should be addressed.
authors.affiliation: Department of Physical Therapy, Saint Louis University, 3437 Caroline Street, St Louis, MO 63104, USA. salsichg@slu.edu
authors.forename: Gretchen B
authors.initials: GB
authors.lastname: Salsich
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mueller
authors.forename: Mary K
authors.initials: MK
authors.lastname: Hastings
authors.forename: David R
authors.initials: DR
authors.lastname: Sinacore
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Strube
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Johnson
mesh_terms: D000125:Achilles Tendon / Q000601:surgery*; D000704:Analysis of Variance; D000843:Ankle Joint / Q000503:physiopathology*; D017719:Diabetic Foot / Q000503:physiopathology / Q000601:surgery*; D003929:Diabetic Neuropathies / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D016523:Foot Ulcer / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000503:physiopathology*; D011446:Prospective Studies; D019415:Torque; D016896:Treatment Outcome