**8. Additional studies**

Additional studies should be done in diabetics to see if frequent eccentric calf stretching can prevent calf tightness, forefoot calluses, forefoot ulceration and

*Tendon Balancing for Diabetic Foot Ulcers, Foot Pain and Charcot Foot DOI: http://dx.doi.org/10.5772/intechopen.105938*

Charcot arthritis. Since calf stretching would not harm diabetic patients, this author recommends prophylactic eccentric calf stretching to these patients.

Achilles tendon lengthening has been recommended to prevent re-ulceration in patients with prior ulcers [27]. More studies are needed to confirm tendon lengthening is helpful in preventing ulceration in patients with progressive callus, prior ulcers, and impending ulcers [27] and whether tendon lengthening should be used as part of primary initial treatment for foot ulcers and Charcot foot [41, 57].

Thomas and Huffman recommended lengthening the Achilles in Charcot foot [55]. More studies should also be done to confirm that tendon lengthening heals most midfoot ulcers [2], transmetatarsal stump ulcers [34], and ischemic wounds of forefoot [48, 49]. Further studies are also needed to confirm tendon lengthening prevents Charcot foot, prevents progression of deformity of Charcot arthritis of the midfoot [2, 10] and ankle, and prevents foot ulcers and amputation in patients with Charcot foot [57].

Preliminary results of tendon lengthening have been encouraging; however, further studies need to be done to confirm tendon lengthening relieves foot pain from multiple causes and prevents foot ulcers, arch collapse, arthritis, amputation and other foot problems.
