To examine the impact of a structured rehabilitation programme as part of an integrated multidisciplinary treatment algorithm for adult spinal deformity patients.

A prospective cohort study was performed over a 2-year period at a major tertiary referral centre for adult spinal deformity surgery. All consecutive patients requiring 2-stage corrective surgery for sagittal malalignment were included (n=32). Details of physiotherapy initial evaluation, inpatient rehabilitation progress, details of bracing treatment and time to discharge were collected. Clinical outcome scores were measured preoperatively and at 6 weeks, 6 months and 1 year postoperatively.

After second stage corrective surgery, the mean time to standing without assistance was 2.1 days, mean time to independent ambulation was 4.2 days, mean time to competent ascending and descending stairs was 5.6 days and mean time to moulded orthosis application 7.1 days. Successful progression through the structured rehabilitation programme was associated with high clinical outcome scores and improved health related quality of life (HRQOL).

The introduction of this programme contributed to the development of an enhanced recovery pathway for patients having adult spinal deformity surgery, reducing inpatient length of stay and optimising clinical outcomes.

Achilles Tendon lengthening was carried out on six patients for the treatment of long standing neuropathic plantar ulcers in the diabetic foot. The results were reviewed after an average of 13 months. Alteration in gait pattern, mobility & resolution of ulcers were assessed. At the time of review, all patients showed complete ulcer healing, none reported any difficulty in mobilisation, despite off loading of the forefoot in each case.

Achilles Tendon Lengthening gives good results in selected patients, particularly those who have not responded to mechanical off loading techniques. The surgical principles & mechanisms of action of the procedure are discussed.