Achilles Tendon Lengthening Surgery: Procedure and Techniques

Could you please provide more details about the Achilles tendon lengthening procedure?

Thank you, doctor, for your previous response.
I would like to ask: how is the surgical procedure for lengthening the Achilles tendon performed? If the tendon is originally only that length, how can it be lengthened?

Yihuo, 20~29 year old female. Ask Date: 2003/02/18

Dr. Shi Guozheng reply Orthopedics

There are several methods for Achilles tendon lengthening, with the most commonly used technique being a Z-plasty, where the tendon is cut in a zigzag pattern, allowing the ends to be pulled to the appropriate length and tension before being reattached.
The second method involves a V-plasty, where the tendon is cut in a V-shape, pulled to the correct length, and then sutured in a Y-shape.
This achieves the desired lengthening; however, care must be taken not to lengthen the tendon excessively, as this could lead to muscle weakness.

Reply Date: 2003/02/18

More Info

Achilles tendon lengthening surgery is a procedure designed to increase the length of the Achilles tendon, which connects the calf muscles to the heel bone. This surgery is often indicated for patients with conditions such as equinus deformity, where the foot is unable to dorsiflex properly due to a tight or shortened Achilles tendon. This can lead to difficulties in walking, running, and performing daily activities.

Procedure Overview
The surgery typically involves a few key steps:
1. Anesthesia: The patient is usually placed under general anesthesia or regional anesthesia, depending on the specific case and the surgeon's preference.

2. Incision: The surgeon makes an incision along the back of the ankle, exposing the Achilles tendon. The length and location of the incision may vary based on the surgical technique used.

3. Tendon Lengthening: There are several techniques for lengthening the Achilles tendon:
- Z-lengthening: This involves making a zig-zag cut in the tendon, allowing it to be lengthened by repositioning the tendon segments.

- Tendon release: In some cases, the tendon may be partially released from its attachment to the heel bone, allowing it to be repositioned and lengthened.

- Gastrocnemius recession: If the calf muscles are also tight, the surgeon may perform a recession of the gastrocnemius muscle, which can help relieve tension on the Achilles tendon.

4. Reattachment: After the tendon has been lengthened, the surgeon will reattach it to the heel bone or secure it in its new position.

5. Closure: The incision is then closed with sutures, and a dressing is applied.

Postoperative Care and Recovery
After the surgery, the patient will typically be placed in a cast or a walking boot to immobilize the foot and allow for proper healing. Physical therapy is often recommended to help regain strength and flexibility in the tendon and surrounding muscles. The recovery time can vary, but patients may need several weeks to months before returning to full activity.

Risks and Considerations
As with any surgical procedure, Achilles tendon lengthening surgery carries risks, including:
- Infection
- Nerve damage
- Blood clots
- Tendon rupture
- Stiffness or weakness in the ankle
It is essential for patients to discuss these risks with their surgeon and understand the potential outcomes of the surgery.

Conclusion
Achilles tendon lengthening surgery can be an effective solution for individuals with a shortened tendon that limits their mobility. By carefully evaluating the patient's condition and employing the appropriate surgical technique, surgeons can help restore function and improve the quality of life for those affected. If you have further questions or concerns about the procedure, it is advisable to consult with a qualified orthopedic surgeon who specializes in foot and ankle surgery. They can provide personalized information based on the specific circumstances and needs of the patient.

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