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What is Achilles Tendon Lengthening?

By Kathy Heydasch
Updated Mar 03, 2024
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Achilles Tendon Lengthening refers mostly to a surgical procedure whereby the tendon is stretched to allow a child or adult to walk flat-footed without a bend in the knee or to relieve chronic pain. The procedure is designed to lengthen a tendon that has not formed properly or has been injured. There are several methods of lengthening the Achilles tendons, with the most mild being physical therapy and/or a brace, and the most aggressive being surgery.

There are three main types of surgery for Achilles tendon lengthening. The first is called a Gastrocnemius recession, and is used only for very mild cases. This procedure targets only the gastrocnemius muscle and attempts to loosen the muscle fibers that are attached to the tendon.

The second type of Achilles tendon lengthening is called percutaneous tendon lengthening, where a surgeon will make several cuts in the tendon. The human body can repair these tears naturally with the production of more muscle tissue, which will add overall length to the tendon. This type of surgery does not allow the surgeon to have much control over the degree of lengthening.

The third and most common type of Achilles tendon lengthening is called z-plasty lengthening. In this case, a surgeon makes a z-shaped cut in the tendon, stretches it to a pre-specified length, and then sutures the tendon back together. This procedure allows the greatest control over the length and enlargement.

Recovery time for these surgeries is usually four to six weeks in some kind of walking cast, during which time there is limited mobility and aggressive physical therapy to allow the tendon to heal properly. If symptoms are mild, surgery may not be worth the risks. Sometimes, however, chronic pain can last a lifetime and a relatively quick and easy surgical procedure could alleviate this discomfort.

Problems with the Achilles tendon can be caused by a number of factors, including genetics, injury and birth defects. When the Achilles tendon is too short, the foot stays in a bent position, with a flat foot forcing the knee to bend or else a person endures considerable pain. Other symptoms might be abnormal toe positions, frequent discomfort in the back of the foot, and poor posture. Muscle spasticity can also be corrected using Achilles tendon lengthening.

Whereas ligaments connect bone to bone, a tendon connects muscle to bone. The strongest tendon in the body is the Achilles tendon, named after a warrior in Greek mythology. The Achilles tendon contracts when necessary to move the bones that allow people to walk, jump, run or stand on their toes.

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Discussion Comments
By anon996274 — On Aug 04, 2016

I was born with a club foot and my foot was four sizes smaller than the other. Since I was born six weeks early, in 1969, I was sent to a children's hospital. I was released six weeks later and my Grandmother noticed that my foot was smaller and turning in, but no doctors could see anything wrong. I was 3 and still could not walk. At the doctor, a very kind lady told my Nan to take me to Surryhills to the Crippled Children's Society.

The moment I got there, the Doctor in Charge said that he was going to New Zealand for two weeks, but would operate the moment he returned,he sent me to have steel rods made up so I could walk in the mean time. When Dr. Clathie returned, I found out he was the head of the children's section at St Vincent Hospital, and he operated there as well as St Margaret's.

I was given a nerve transplant with a small scar on the left and a longer one on the right. I was told I was the first in NSW to have the Achilles tendon lengthened at the back instead of the front of the foot, and was told never to do sport.

At nine, I had a growth spurt. My mother looked into the medication they give dancers, but Dr. Clathie was astounded at the mere mention. My Father is 6 feet tall and my Mother is 5 foot 9, my brother is 6'3 and other brother is 6'6. I was tested and showed I would be between 5'5 to 5'7 like my Nana. I am 5'6.

At nine I had to have the Achilles tendon lengthened again and I had a ulcer form under the plaster as it was going over scar tissue. My Nana worked out it would heal as long as it was kept dry and stopped the knitting needle I used for itchy red raw skin.

At 22, I could not walk without my foot feeling it was in hot oil, but being a stubborn teenager at 15, I refused to back to see Dr. Clathie as we had moved to Goulburn When my Pop had retired, Dr. Clathie would see all his patients once a year at Surryhills.

I was no longer under the care of an orthopedic surgeon. We had moved to the Central coast NSW.

I took my Nana with me and the doctor I saw said the foot was aging double to me, to keep my weight down and stay off the foot, as well or by the time I am 40, I will need the foot removed. I could not stay off the foot. I worked 10 hours, five days a week in a service station as well as having no chair to sit on. I weighed 50kg and I had to carry 50kg of wood to customers' cars as well as gas bottles and many other duties.

At 39, my foot started to go inwards. Well, before that, it took a few years to find a surgeon willing to operate over scar tissue. In 2007, the pain from the burning was so bad as well as the arthritis and ulcerated esophagus. I was sad that it came to this. I was put on Oxycontin and had the operation at 40 in 2009 At a hospital in Castle Craig, to stop my foot from going inwards but the burning is still there.

My uncle got news in May 2009 that he had cancer, my Nana had a massive heart attack and she held on for four days. My uncle passed away 24 hours after my Nana. I was with both of them when they were taken home, and they are a huge part of my soul just as my Pop. They're all together now.

My foot now goes dead if I am in traffic for over a hour, so I'm on restricted driving. I also get cramps in my good foot starting in the muscle just under the knee, cramps down to sole of foot . Without medication, I have to drag my club foot. It does feel dead, and to top it off they found gallstones last year. They tried to remove them but I was allergic to the drugs that knock you out, so I ended up in ICU.

All those years ago, I believed the doctor who said my foot would be dying now. I am sure of it.

Peace and pain free to each of you. Regards from Lisa

By anon927896 — On Jan 26, 2014

I have Tendinosis and this is caused by my short achilles. No doctor wants to perform surgery! The doctors said it would be worse for me.

By pleonasm — On Sep 02, 2013

@MrsPramm - Potentially, yes, I suppose, but in reality there's no way I'd want to risk it. An Achilles tendon tear is extremely painful and often people end up needing surgery for it anyway.

If possible, I would suggest that people try to lengthen their tendons with gentle stretching over time, but people who have serious problems, like kids who were born with short tendons, really do need the surgery.

By MrsPramm — On Sep 01, 2013

@clintflint - I remember when those shoes that are designed to make you feel like you're walking in sand came out, and they had a warning that women who wear heels need to be careful, because they could potentially rip their Achilles tendon if it was too tight. The shoes were designed to make your foot angle in the opposite direction to where it would be going in heels, so there was a real danger of injury.

Although, considering that these Achilles tendon lengthening surgeries seem to mostly consist of cutting the tendons, I wonder if ripping it by accident might not be a cheaper way to eventually recover full motion!

By clintflint — On Aug 31, 2013

This kind of Achilles tendon injury is often caused in women by wearing high heels too often. Because they keep shortening the Achilles tendon when they are wearing the heels eventually it grows that way and it becomes too short to straighten properly.

You have to be wearing heels all day every day, but there are plenty of women who do this, of course and then they end up getting to the point where they can't wear anything except heels, because wearing other kinds of shoes straightens out the tendon too much.

I've even heard that some of them refuse the surgery because they don't really see it as a problem. I think that people should just see heels as an occasional accessory, myself, since they are so bad for you. Wearing them all the time is a health hazard.

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