Percutaneous Achilles Tendon Lengthening

 
Pre-operative incision markings along the Achilles tendon.

What is the goal of a percutaneous Achilles tendon lengthening?

The goal of this procedure is to stretch a tight Achilles tendon. This allows increased motion at the ankle joint.
 

What signs indicate surgery may be needed?

People with a tight Achilles tendon tend to walk on their toes. The tight Achilles tendon prevents the foot from sitting flat on the floor, and ankle motion can be limited. When this tightness cannot be treated with nonsurgical stretching or physical therapy, surgery is indicated.
 
This procedure may be only one part of a surgery to help correct a mal-positioned foot. Patients that develop ulcers in the front part of the foot may require an Achilles lengthening to decrease pressure on the front part of the foot and allow the ulcers to heal.  
 

When should I avoid surgery?

This procedure is not recommended when there is active infection or redness around the Achilles tendon. A very tight tendon may require a more complex lengthening surgery.
 
 
Extent of ankle mobility before Achilles lengthening surgery.

General Details of Procedure

The procedure is minimally invasive. It may be done alone or with other procedures in order to improve the overall position of the foot. It is typically an outpatient procedure, and general or regional anesthesia is typically used. It only takes a few minutes to perform this procedure.
 

Specific Techniques

The surgeon makes three small incisions at the back of the ankle along the Achilles tendon. The tendon is cut approximately 50 percent at each of these three sites in an alternating pattern. The surgeon does this while an assistant is holding the ankle and stretching the tendon. The tendon stretches as the fibers are cut.
 

What happens after surgery?

Healing time for tendons is approximately six to eight weeks. You may be in a protective cast, splint or walking boot initially while the tendon heals. Physical therapy and rehabilitation is often needed after the initial healing period to help with strength and range of motion.
 
 
Extent of ankle mobility after Achilles lengthening surgery.

Potential Complications

There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
 
With a percutaneous Achilles tendon lengthening, specific complications are rare. Wound problems such as nonhealing incisions or infection can occur. The Achilles tendon can remain tight after surgery. The Achilles tendon can also completely rupture during surgery or recovery.
 

Frequently Asked Questions

 
When will I be able to walk again after this procedure?
Generally, the Achilles tendon will take about six to eight weeks to heal, so weight bearing and therapy will likely begin at that point. It may take several months to be able to walk normally. The routine post-operative course may be altered if other procedures are performed.
 
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