ACHILLES TENDON LENGTHENING ON PATIENTS WITH DIABETES

描述（改编自申请人摘要）：糖尿病患者 糖尿病（DM）和周围神经病变是前足的高风险 足底溃疡和随后的下肢截肢。 总接触 铸造目前是最有效的治疗愈合神经病变 足底溃疡，但溃疡复发率高（30-50%）， 停止施法继续行走 马蹄足畸形（踝关节受限 背屈活动范围[ROM]）与这些复发性 溃疡 虽然描述性证据表明跟腱延长 手术（纠正马蹄足畸形）可以提高愈合率 在慢性溃疡方面，还没有对照试验。 主 本研究的目的是进行一项随机、前瞻性、对照 确定经皮跟腱延长和完全接触 铸造比完全接触铸造更有效地治愈前足 足底溃疡 第二个目的是确定铸造的效果 和经皮跟腱延长术对损伤、功能 限制和残疾的患者与糖尿病和周围神经病变。 该项目的具体目标是确定 跟腱延长术治疗糖尿病周围神经病变 前足溃疡和马蹄畸形，涉及1）伤口愈合，2） 损伤（背屈活动范围、跖屈肌 性能），3）功能限制（物理性能测试， 功能性伸展，行走能力），和4）残疾（SF 36）。 结果 将对预防伤口感染和降低 肢体截肢;和改善损伤，功能 局限性和残疾，在这组高危患者的慢性 疾病

DESCRIPTION (Adapted from the Applicant's Abstract): 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 [ROM]) is associated with these recurrent ulcers. Although descriptive evidence indicates an Achilles lengthening procedure (which corrects the equinus deformity) can improve healing rates in chronic ulcers, there have been no controlled trials. The primary purpose of this study will be to conduct a randomized prospective controlled trial to determine if percutaneous Achilles lengthening and total contact casting is more effective than total contact casting alone to heal forefoot plantar ulcers. Secondary purposes are to determine the effects of casting and percutaneous Achilles 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.