Achilles Tendon Lengthening in Patients With Diabetes to Prevent Foot Ulcers

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00006426
Recruitment Status : Completed
First Posted : November 2, 2000
Last Update Posted : June 24, 2005
Information provided by:
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

Brief Summary:
People with diabetes often develop severe skin problems (ulcers) on their feet. Sometimes these are treated with surgery and other times by temporarily immobilizing the foot in a cast. This study compares the effect of surgery to lengthen the Achilles tendon and put the foot in a cast, to using a cast alone. The study will also examine how foot strength, joint movement, and overall ability to walk, balance and climb stairs is affected.

Condition or disease Intervention/treatment Phase
Diabetes Mellitus Foot Ulcer Peripheral Neuropathy Procedure: Achilles tendon-lengthening surgery Phase 1

Detailed Description:

Patients with diabetes mellitus (DM) and peripheral neuropathy are at high risk for forefoot plantar ulcers and subsequent lower extremity amputation. Total contact casting currently is the most effective treatment for healing neuropathic plantar ulcers but ulcer recurrence is high (30-50%) when patients discontinue casting and resume walking. An equinus deformity (limited ankle dorsiflexion range-of-motion) is associated with these recurrent ulcers. Although descriptive evidence indicates an Achilles lengthening procedure (which corrects the equinus deformity) can improve healing rates in these chronic ulcers, there have been no controlled studies.

This randomized prospective controlled clinical trial will determine if percutaneous Achilles lengthening and total contact casting is more effective than total contact casting alone in healing forefoot plantar ulcers (n=30/group will allow detection of 25% effect with power of 0.8 at alpha level of 0.05). Secondary purposes are to determine the effects of casting and percutaneous lengthening on measures of impairments, functional limitations, and disability in patients with DM and peripheral neuropathy. The specific aims of this project are to determine the effect of the Achilles lengthening procedure on patients with DM, peripheral neuropathy, a forefoot ulcer, and an equinus deformity in regards to 1) Wound healing, 2) Impairments (dorsiflexion range-of-motion, plantar flexor muscle performance), 3) Functional Limitations (Physical Performance Test, Functional Reach, walking ability), and 4) Disability (SF36). The results will have important implications for prevention of wound infection and lower extremity amputation; and improvement in impairments, functional limitations, and disability in this group of high risk patients with chronic disease. Approximately 30 patients will be recruited for each of the treatment groups.

Study Type : Interventional  (Clinical Trial)
Enrollment : 60 participants
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Controlled Clinical Trial Comparing the Effect of an Achilles Tendon Lengthening Procedure and Casting to Casting Alone for the Treatment of Neuropathic Forefoot Plantar Ulcers in Patients With Diabetes Mellitus
Study Start Date : August 1998
Study Completion Date : May 2003

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Foot Health
U.S. FDA Resources

Information from the National Library of Medicine

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Ages Eligible for Study:   Child, Adult, Senior
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • History of Diabetes Mellitus
  • Limitation of dorsiflexion ankle range of motion to zero degrees or less
  • Recurrent or nonhealing ulcer (Grade II, Wagner scale)

Exclusion Criteria:

  • Nonambulatory patients or those that would not benefit from the Achilles lengthening procedure.
  • Patients with a history of CVA or other significant neurological problems complicating their rehabilitation.
  • Patients with a history of midfoot or hindfoot Charcot fractures.
  • Patients with an Ankle-Arm index < 0.45 or absolute toe pressure < 40 mm Hg.
  • Patients medically unfit for the anesthesia required for this Achilles lengthening procedure.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00006426

United States, Missouri
Barnes-Jewish Hospital, Orthopedic Surgery
St. Louis, Missouri, United States, 63110
Sponsors and Collaborators
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Principal Investigator: Michael J. Mueller, Ph.D., P.T. Program in Physical Therapy, Washington University

Additional Information:
Publications: Identifier: NCT00006426     History of Changes
Other Study ID Numbers: NICHD-0109
1R01HD036802 ( U.S. NIH Grant/Contract )
First Posted: November 2, 2000    Key Record Dates
Last Update Posted: June 24, 2005
Last Verified: March 2003

Keywords provided by Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD):
Foot ulcers
Peripheral neuropathy
Achilles Lengthening
Ambulatory surgery
Foot deformity

Additional relevant MeSH terms:
Diabetes Mellitus
Foot Ulcer
Peripheral Nervous System Diseases
Glucose Metabolism Disorders
Metabolic Diseases
Endocrine System Diseases
Pathologic Processes
Foot Diseases
Skin Diseases
Leg Ulcer
Skin Ulcer
Neuromuscular Diseases
Nervous System Diseases