Midfoot Charcot Arthropathy with Improvement of Arch after Achilles Tendon Lengthening: A Case Report

Abstract

Level of Evidence: V, Expert Opinion

Preliminary Results of Primary Gastrocnemius-Soleus Recession for Midfoot Charcot Arthropathy

“…Holthusen and Kolodziej found improvement in arch alignment after Achilles tendon lengthening in a patient with Charcot foot whose arch collapsed while in a total contact cast. 14 They felt Achilles lengthening can reduce deformity and ulceration in patients with Charcot foot. Mueller et al reported 81% (21/26) forefoot ulcer recurrence 2 years after healing with total contact casting alone but only 37% (10/27) recurrence if Achilles lengthening was added.…”

“…10-12 Achilles tendon lengthening and GSR have been recommended as an adjunctive treatment for the Charcot foot. 1,2,5,9-11,13-15 Hastings et al showed that lengthening the Achilles tendon improved ankle dorsiflexion, decreased peak plantar pressures, and improved overall walking ability in a diabetic patient. 16 A systematic review of surgical management in Charcot foot patients gave lengthening of the Achilles tendon or gastrocnemius muscle a Grade B recommendation.…”

Radiographic correction of Achilles tendon lengthening in diabetic patients with high risk for foot ulceration

“…A single case report has described radiographic improvement in arch height in an at-risk patient with CNA following TAL. 7 The purpose of the present study is to investigate the effectiveness of the TAL in those with midfoot collapse. We aim to quantify this in terms of average radiographic correction obtained across a series of patients.…”