Managing Equinus In Patients With Diabetes

Start Page: 68
75
Author(s): 
Patrick DeHeer, DPM, FACFAS, and Brandon Borer, DPM

   In this study, the preoperative group had 1 degree of ankle joint dorsiflexion with the knee extended. After gastrocnemius recession, single and double dorsiflexion increased significantly (9 and 15 degrees respectively). Adding a soleus recession only increased dorsiflexion by 1 degree. Therefore, it is more effective to perform a double gastrocnemius recession.

In Conclusion

When it comes to preventative care that has been championed over the past two decades for the patient with diabetes, there has been significant progress in amputation prevention. The one missing piece to the puzzle that has been ignored is the treatment of equinus. With adequate treatment of those patients with diabetes who have equinus, we can further decrease their risk of ulceration and amputation.

   Dr. DeHeer is a Fellow of the American College of Foot and Ankle Surgeons, and a Diplomate of the American Board of Podiatric Surgery. He is also a team podiatrist for the Indiana Pacers and the Indiana Fever. Dr. DeHeer is in private practice with various offices in Indianapolis.

   Dr. Borer is a first-year resident at Westview Hospital in Indianapolis.

References
1. Johnson CH, Christensen JC. Biomechanics of the first ray part V: the effect of equinus deformity. J Foot Ankle Surg. 2005;44(2):114-120.
2. Opila KA, Wagner SS, Schiowitz S, Chen J. Postural alignment in barefoot and high-heeled stance. Spine. 1998;13(5):542-547.
3. Sgarlato TE, Morgan J, Shane HS, Frenkenberg A. Tendo Achilles lengthening and its effect on foot disorders. J Am Podiatry Assoc. 1975; 65(9):849-871.
4. DiGiovanni CW, Kuo R, Tejwani N, Price R, Hansen Jr. ST, Cziernecki J, Sangeorzan BJ. Isolated gastrocnemius tightness. J Bone Joint Surg Am. 2002; 84-A(6):962-970.
5. Aronow MS, Diaz-Doran V, Sullivan RJ, Adams DJ. The effect of triceps surae contracture force on plantar foot pressure distribution. Foot Ankle Int. 2006; 27(1):43-52.
6. Jones RL. The human foot. An experimental study of its mechanics, and the role of its muscles and ligaments in the support of the arch. Am J Anat. 1941; 68:1-38.
7. Ward ED, Phillips RD, Patterson PE, Werkhoven GJ. The effects of extrinsic muscle forces on the forefoot-to-rearfoot loading relationship in vitro. J Am Podiatr Med Assoc. 1998;88(10):471-482.
8. Mueller MJ, Sinacore DR, Hastings MK, Strube MJ, Johnson JE. Effect of Achilles tendon lengthening on neuropathic plantar ulcers. A randomized clinical trial. J Bone Joint Surg. 2003;85-A(8):1436-1445.
9. Grant WP, Sullivan R, Sonenshine DE, Adam M, Slusser JH, Carson KA, Vinik AI. Electron microscopic investigation of the effects of diabetes mellitus on the Achilles tendon. J Foot Ankle Surg. 1997;36(4):272-278.
10. Lavery LA, Armstrong DG, Boulton AJ. Ankle equinus deformity and its relationship to high plantar pressure in a large population with diabetes mellitus. J Am Podiatr Med Assoc. 2002;92(9):479-482.
11. Radford JA, Burns J, Buchbinder R, Landorf KB, Cook C. Does stretching increase ankle dorsiflexion range of motion? A systematic review. Br J Sports Med. 2006; 40(10):870-875.
12. Grady JF, Saxena A. Effects of stretching the gastrocnemius muscle. J Foot Surg. 1991;30(5):465-469.
13. Hill RS. Ankle equinus. Prevalence and linkage to common foot pathology. J Am Podiatr Assoc. 1995;85(6):295-300.
14. Evans A. Podiatric medical applications of posterior night stretch splinting. J Am Podiatr Med Assoc. 2001;91(7):356-360.
15. Herzenberg JE, Lamm BM, Corwin C, Sekel J. Isolated recession of the gastrocnemius muscle: the Baumann procedure. Foot Ankle Int. 2007;28(11):1154-1159.

   For further reading, see “Understanding And Managing Equinus Deformities” in the May 2011 issue of Podiatry Today or the DPM Blog “Why Do We Overlook Equinus In Patients With Diabetes?” at http://tinyurl.com/5t2ug69 .

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