Understanding How The Achilles Tendon Affects Plantar Pressure
- Volume 22 - Issue 5 - May 2009
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It is crucial to examine and address other potential causes of increased plantar forefoot pressure such as hammertoes, long and/or plantarflexed metatarsals, fat pad atrophy or other foot positional stresses. We need to educate our patients about stretching of the Achilles tendon, using accommodative insoles and wearing proper shoe gear.
The question remains as to whether one should preventively lengthen the Achilles tendon or address the tendon after the ulceration has occurred. Achilles lengthening may serve as a beneficial method to heal and prevent neuropathic forefoot ulceration.
The Achilles lengthening or gastrocnemius recession can have a profound effect in decreasing peak plantar pressures at the forefoot and increasing ankle dorsiflexion. This can result in a greater percentage of healed diabetic foot ulcers and reduced healthcare costs.
Dr. Wilson is in practice at Kaiser Permanente Medical Center in Springfield, Va.
Dr. Steinberg is an Assistant Professor in the Department of Plastic Surgery at the Georgetown University School of Medicine in Washington, D.C. Dr. Steinberg is a Fellow of the American College of Foot and Ankle Surgeons.
For further reading, see “Tendo-Achilles Lengthening: Friend Or Foe In The Diabetic Foot?” in the November 2007 issue, “Tendon Lengthening: Is It A Viable Option For Forefoot Ulcers?” in the July 2005 issue, “Addressing Tendon Balancing Concerns In Diabetic Patients” in the March 2003 issue, “A Guide To Offloading The Diabetic Foot” in the September 2005 issue or “Offloading The Plantar Fascia: What You Should Know” in the November 2005 issue.
To check out the archives or get information on reprints, visit www.podiatrytoday.com.
1. American Diabetes Association Web site, http://www.diabetes.org/diabetes-statistics.jsp, accessed on Feb. 28, 2009.
2. Batista F, Nery C, Pinzur M, et al. Achilles tendinopathy in diabetes mellitus. Foot Ankle Int 29(5):498-501, 2008.
3. Orendurff MS, Rohr ES, Sangeorzan BJ, et al. An equinus deformity of the ankle accounts for only a small amount of the increased forefoot plantar pressure in patients with diabetes. J Bone Joint Surg (Br) 88(1):65-68, 2006.
4. Caselli A, Pham H, Giurini JM. The forefoot to rearfoot plantar pressure ratio is increased in severe diabetic neuropathy and can predict foot ulceration. Diabetes Care 25(6):1066-71, 2002.
5. Nishimoto GS, Attinger CE, Cooper PS. Lengthening the Achilles tendon for the treatment of diabetic plantar forefoot ulceration. Surg Clin North Am 83(3):707-26, 2003.
6. Salsich GB, Mueller M, Hastings MK, et al. Effect of Achilles tendon lengthening on ankle muscle performance in people with diabetes mellitus and a neuropathic plantar ulcer. Phys Ther 85(1):34-43, 2005.
7. Lavery L, Armstrong D, Boulton A. Ankle equinus deformity and its relationship to high plantar pressure in a large population with diabetes mellitus. J Am Podiatr Med Assoc 92(9):479-82, 2002.