Impact of Achilles tendon lengthening on functional limitations and perceived disability in people with a neuropathic plantar ulcer

Abstract

OBJECTIVE - An Achilles tendon-lengthening (ATL) procedure is effective at reducing ulcer recurrence in patients with diabetes, peripheral neuropathy, and a plantar ulcer, but its effects on functional limitations and perceived disability are unknown. The purpose of this study is to report the effects of an ATL and total Contact casting (TCC) on the functional limitations and perceived disability of patients with neuropathic plantar ulcers. RESEARCH DESIGN AND METHODS - Twenty-eight subjects with a mean age of 55 ± 10 years and a BMI of 33 ± 6 kg/m2 participated. All subjects had a history of diabetes, loss of protective sensation, limited ankle motion, and a recurrent forefoot ulcer. Subjects were randomized into two groups: an ATL group (n = 14), who received treatment of ATL, and TCC and a TCC group (n = 14), who received TCC only. Subjects completed a modified physical performance test (PPT) and the SF-36 Health Survey before treatment, after primary treatment and healing of the plantar forefoot ulcer, and 8 months after initial ulcer healing. RESULTS - There were no significant changes in functional limitations as measured by the PPT between groups or over time. The physical summary score of the SF-36 decreased slightly from before treatment to 8 months after initial ulcer healing in the ATL group (35 ± 7 to 31 ± 6), whereas the TCC group score increased during this time (34 ± 8 to 39 ± 11; P < 0.05). CONCLUSIONS - The ATL resulted in no measurable change in functional limitations, but patients receiving an ATL and TCC reported lower physical functioning at 8 months after initial ulcer healing than subjects receiving TCC alone and may require additional physical therapy to address this perceived disability.