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Cited by 353Diabetic Foot Ulcer Assessment and ManagementFoot and Ankle SurgeryLower Extremity Biomechanics and Pathologies

The DOI matches its Crossref record; 23 of the 23 references it cites were found in a registry or an index.

EFFECT OF ACHILLES TENDON LENGTHENING ON NEUROPATHIC PLANTAR ULCERS☆: A RANDOMIZED CLINICAL TRIAL

MUELLER, MICHAEL J., SINACORE, DAVID R., HASTINGS, MARY KENT, STRUBE, MICHAEL J., JOHNSON, JEFFREY E.·2003·The Journal of Bone and Joint Surgery-American Volume
DOI 10.2106/00004623-200308000-00003
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Abstract

Background: Limited ankle dorsiflexion has been implicated as a contributing factor to plantar ulceration of the forefoot in diabetes mellitus. The purpose of this study was to compare outcomes for patients with diabetes mellitus and a neuropathic plantar ulcer treated with a total-contact cast with and without an Achilles tendon lengthening. Our primary hypothesis was that the Achilles tendon lengthening would lead to a lower rate of ulcer recurrence. Methods: Sixty-four subjects were randomized into two treatment groups, immobilization in a total-contact cast alone or combined with percutaneous Achilles tendon lengthening, with measurements made before and after treatment, at the seven-month follow-up examination, and at the final follow-up evaluation (a mean [and standard deviation] of 2.1 ± 0.7 years after initial healing). There were thirty-three subjects in the total-contact cast group and thirty-one subjects in the Achilles tendon lengthening group. There were no significant differences in age, body-mass index, or duration of diabetes between the groups. Outcome measures were time to healing of the ulcer, ulcer recurrence rate, range of dorsiflexion of the ankle, peak torque (strength) of the plantar flexor muscles, and peak plantar pressures on the forefoot. Results: Twenty-nine (88%) of thirty-three ulcers in the total-contact cast group and all thirty ulcers (100%) in the Achilles tendon lengthening group healed after a mean duration (and standard deviation) of 41 ± 28 days and 58 ± 47 days, respectively (p > 0.05). (One patient in the Achilles tendon lengthening group died before treatment was completed.) In the first seven months of follow-up, sixteen (59%) of the twenty-seven patients in the total-contact cast group who were available for follow-up and four (15%) of the twenty-seven patients in the Achilles tendon lengthening group who were available for follow-up had an ulcer recurrence (p = 0.001). At the time of the two-year follow-up, twenty-one (81%) of the twenty-six patients in the total-contact cast group and ten (38%) of the twenty-six patients in the Achilles tendon lengthening group had ulcer recurrence (p = 0.002). Compared with the group treated with the total-contact cast, the group treated with Achilles tendon lengthening had increased dorsiflexion and it remained increased at seven months (p < 0.001). Plantar flexor peak torque also decreased after Achilles tendon lengthening (p < 0.004), but it returned to baseline after seven months. Peak plantar pressures on the forefoot during barefoot walking were reduced (p < 0.0002) following Achilles tendon lengthening yet returned to baseline values within seven months after treatment. Conclusions: All ulcers healed in the Achilles tendon lengthening group, and the risk for ulcer recurrence was 75% less at seven months and 52% less at two years than that in the total-contact cast group. Achilles tendon lengthening should be considered an effective strategy to reduce recurrence of neuropathic ulceration of the plantar aspect of the forefoot in patients with diabetes mellitus and limited ankle dorsiflexion (≤5°). Level of Evidence: Therapeutic study, Level I-1a (randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.

Overview

Integrity signals

Registry

Crossref · 10.2106/00004623-200308000-00003

Cites

23 of 23 references verified0 citation errors · 0 not checkable

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Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Two national surveys of clinicians in the United States and Australia show that the total contact cast was used in only 2% and 15% of patients, respectively, as a primary means of off-loading.

    “Two national surveys of clinicians in the United States and Australia show that the total contact cast was used in only 2% and 15% of patients, respectively, as a primary means of off-loading.56,57”

    From Diabetic Foot Ulcers: A Review (2023) · cites this paper as [56]

  • Clinicians frequently cited patient preference as a reason for lack of total contact cast use.

    “Clinicians frequently cited patient preference as a reason for lack of total contact cast use.56”

    From Diabetic Foot Ulcers: A Review (2023) · cites this paper as [56]

Citations

Cites

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Research works printed but not linked: 5

  1. 1984, Arch Phys Med Rehabil, 65, 691
  2. 1991, Arch Phys Med Rehabil, 72, 967
  3. 1984, Compr Ther, 10, 29
  4. 1988, J Bone Joint Surg Br, 70, 472
  5. 1972, J Bone Joint Surg Br, 54, 272

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Metadata

Authors
MUELLER, M. J., SINACORE, D. R., HASTINGS, M. K., STRUBE, M. J., & JOHNSON, J. E.
ORCID
Venue
The Journal of Bone and Joint Surgery-American Volume
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2003-08
Volume
85
Issue
8
Pages
1436-1445
ISSN
0021-9355 (ISSN-L)
DOI
10.2106/00004623-200308000-00003
OpenAlex
W4320581071
Cited by
353
References
23
Citations by year
2026: 6 · 2025: 10 · 2024: 14 · 2023: 16 · 2022: 29 · 2021: 12 · 2020: 19 · 2019: 10 · 2018: 12 · 2017: 8 · 2016: 21 · 2015: 26 · 2014: 16 · 2013: 19 · 2012: 19
FWCI
8.14
Type
journal article
Language
en
Open access
closed
Locations
Journal of Bone and Joint Surgery (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetic Foot Ulcer Assessment and Management
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Foot and Ankle Surgery
  • Physical Sciences › Engineering › Biomedical Engineering › Lower Extremity Biomechanics and Pathologies
Keywords
Achilles tendon lengthening, neuropathic ulcer, total contact cast, ulcer recurrence, ankle dorsiflexion, plantar pressure, diabetic foot, ulcer healing time, foot ulcer prevention, foot deformity correction

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