Effect of Achilles tendon lengthening on ankle muscle performance in people with diabetes mellitus and a neuropathic plantar ulcer.
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.
Salsich
Gretchen B
GB
Department of Physical Therapy, Saint Louis University, 3437 Caroline Street, St Louis, MO 63104, USA. salsichg@slu.edu
Mueller
Michael J
MJ
Hastings
Mary K
MK
Sinacore
David R
DR
Strube
Michael J
MJ
Johnson
Jeffrey E
JE
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