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Podiatry Today has just published the full text of: Tendo-Achilles Lengthening: Friend Or Foe In The Diabetic Foot?
Paul J. Kim, John S. Steinberg
Quote:
While various researchers have implicated the equinus deformity as a major deforming force in a host of foot and ankle pathologies, the exact definition of equinus remains unclear.1-4 However, Root states that “the minimal range of ankle joint dorsiflexion that is necessary for normal locomotion is 10 degrees.”5 Subsequent studies report that the ankle joint range of motion for asymptomatic patients ranges from 0 to 13.1 degrees with the knee extended and from 5 to 22.3 degrees with the knee flexed.
The implication from these studies and other papers is that with a decrease in the range of motion at the ankle joint, it is more likely that pathologies will develop. Although other soft tissue and bony constraints may restrict ankle joint range of motion, the Achilles tendon appears to play the dominant role for this limitation.
Multiple factors are involved in the development of pathologies one sees in the diabetic foot. Some of these factors include neuropathy, ischemia and bony deformity. Soft tissue changes in the diabetic foot are particularly important. For example, there is a decrease in the soft tissue density on the plantar aspect of the diabetic foot, which is less tolerant of stress.10-12 We also know that patients with diabetes have less mobility available in their joints.
Achilles tendon lengthening in the diabetic foot
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