Understanding Achilles Tendon Lengthening Procedures

Understanding Achilles Tendon Lengthening Procedures

The Achilles tendon, located at the back of the ankle, connects the heel bone to the calf muscles. It allows you to point your toes and push off when walking, running or jumping. Achilles tendon problems can cause pain, swelling and impaired mobility.

In some cases, a tightened Achilles tendon may fail to stretch adequately, limiting ankle flexibility. This tightness pulls the heel bone into a permanently pointed position, leading to issues like toe-walking or painful foot deformities.

What Causes a Short, Tight Achilles Tendon?

There are a few potential causes of Achilles contractures leading todevelopment:

• Cerebral palsy
• Clubfoot
• Injury, arthritis or tendonitis
• Casting after injury when immobile
• Genetic factors
• Aging-related loss of flexibility

When conservative treatments like rest, ice, orthotics or physical therapy fail to alleviate persistent tightness and accompanying mobility restrictions, surgical lengthening may provide relief.

Goals of Achilles Tendon Lengthening

These procedures aim to:

• Increase ankle flexibility and range of motion
• Improve ability to walk, exercise or participate in sports
• Decrease risk of complications related to limited mobility
• Reduce strain on the Achilles tendon
• Minimize pressure and pain in the foot and ankle

By surgically releasing a tightened Achilles, the ankle can achieve proper position and alignment, enabling normal function.

About the Achilles Tendon Lengthening Procedure

First, its important to note Achilles tendon lengthening does not actually lengthen the tendon itself. Surgeons perform selective sectioning of the tendon at different points to allow increased range of motion.

Who is a Good Candidate?

Those experiencing chronic stiffness and inflexibility arising from Achilles contracture that impedes mobility and quality of life may benefit. Ideal candidates include:

• Children over age 4
• Well-nourished, healthy individuals
• Non-smokers
• Those committed to post-op rehab

The surgeon will determine if shortening has stabilized before operating, as those still growing have a higher risk of recurrence.

Preparing for Lengthening Surgery

Preparing properly prior to the procedure facilitates optimal surgical experience and recovery:

• Discontinue blood thinning medications
• Stop smoking for healing enhancement
• Complete pre-op clearances and lab testing
• Arrange a ride home post-surgery
• Prep home with medical supplies for rehab

Following all pre-operative instructions provided by your surgical team reduces complications risks and sets the stage for the best result.

How the Lengthening is Performed

There are a few well-established surgical techniques to lengthen the Achilles, often done under general anesthesia as an outpatient procedure. The surgery itself takes between 1-2 hours.

The surgeon partially severs the tendon at strategic points, allowing the ankle and heel cord to be manipulated into an improved position. They may also need to lengthen or transfer tendons near the heel to rebalance the foot.

One common method, percutaneous triple hemisection, divides the tendon into three intervals, while minimizing incisions through small skin punctures.

Recovery Process and Rehabilitation

After surgery, the foot is immobilized in a cast or splint for initial healing, typically around 6 weeks. Your surgeon will provide specific walking instructions with assistive devices like crutches or a boot.

Once adequate healing allows weaning from the immobilization device, structured physical therapy starts to restore strength and mobility. Gentle stretching, range of motion exercises, ultrasound and massage minimize scar tissue formation while improving flexibility.

With proper technique, children can often return to normal activity around 3 months post-op. But recovery takes 9-12 months for full remodeling. Proper rehabilitation adherence remains crucial long-term.

Risk Factors and Complications

While serious complications are relatively rare when performed by an experienced orthopedic foot and ankle specialist, risks include:

• Infection
• Nerve injury
• Abnormal scarring
• Re-rupture of tendon
• Recurrence of contracture
• Chronic pain or weakness

Smoking, diabetes and certain medications increase chances of post-surgical problems. Strictly following your surgeons pre- and post-operative protocols reduces risks.

Is Repeat Lengthening Ever Needed?

In some cases, the Achilles tightens again later in life after initially successful lengthening. Previous surgery usually changes the mechanics of repeat healing processes. Discussion with your doctor can determine if another lengthening is appropriate down the road.

Consistentstretching, orthotics, bracing and exercise help reinforce gains from tendon release procedures and prevent future contractions. Some may also benefit from serial casting, Botox or phenol injectionsto continually improve flexibility.

Achilles tendon lengthening aims to provide long-term relief from debilitating foot problems. Working closely with your surgical team before and after the procedure ensures you heal properly. Stay motivated through rehabilitation for the best outcome.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.