A comprehensive literature search was conducted across PubMed and Embase for publications referencing "Acute Charcot Neuropathy" (ACN) and/or "tendon release" to ensure broad and relevant search parameters. A steering group was established to classify Achilles tightness and standardize the definition of ACN. We evaluated the incidence of Achilles tightness within the ACN patient population and compared casting times against control groups that did not undergo an Achilles release. The included studies were assessed to determine whether patients subsequently developed fractures, deformities, or new ulcerations, and whether additional surgery was required. The Cochrane Risk of Bias tool was utilized to evaluate the quality of the trials included in this review. These findings were then compared with established data from patients who had not undergone Tendo-Achilles Lengthening (TAL) to determine if TAL significantly improves outcomes in the setting of stage 0 Charcot. Initial findings indicate that Achilles release, alongside early diagnosis and proper off-loading, can indeed be beneficial in preventing deformities. However, larger-scale studies utilizing well-defined ACN staging criteria are necessary to fully understand the efficacy of TAL in the management of acute Charcot Neuropathy. Keywords: Charcot neuroarthropathy (CN), diabetic foot, Achilles, gastrocnemius, total contact casting (TCC), ulcer, Tendon Achillies Lengthening (TAL)

Dr Bhagyashree Singh is an advanced practice Physiotherapist at NHS hospital London, but also a medical doctor graduating in June 2026 from the University of Novi Sad. She has a bachelor’s degree in Physiotherapy, a masters/Msc degree in MSK/Musculoskeletal medicine and biomechanics from UK, She has more than 10 years of extensive experience working in different advanced MSK settings in the NHS hospitals in the UK. Her area of interest is MSK medicine, biomechanics and physical rehab. She has previously been involved in various research on physical medicine and physiotherapy