Tendo-achilles lengthening and total contact casting for plantar forefoot ulceration in diabetic patients with equinus deformity of the ankle

Total contact casting has been successful in treating neuropathic foot ulcers, but little information is available about treating patients with diabetes mellitus for whom total contact casting treatment for forefoot ulceration fails. Equinus deformity of the ankle and limited joint motion in a neuropathic foot can lead to abnormal foot pressures, resulting in failure of total contact casting. This report describes the technique of tendo-Achilles lengthening in conjunction with total contact casting and reports the results achieved in a randomly selected group of diabetic patients with unhealed forefoot ulcerations. Surgical correction with percutaneous tendo-Achilles lengthening and total contact casting can result in rapid healing of the forefoot ulcer and helps prevent ulcer recurrence.