The Achilles tendon plays a vital role in our mobility. When this tendon becomes too tight or shortened, it can keep us from moving normally and cause pain — OrthoNebraska can help.
Achilles tendon lengthening surgery is a proven procedure designed to relieve tightness at the back of the lower leg, restore flexibility and improve gait and comfort for both adults and children. It is more often done in combination with other procedures than performed on its own.
What Is Achilles Tendon Lengthening?
Achilles tendon lengthening (ATL) is a surgical procedure that carefully stretches and extends the Achilles tendon, which connects your calf muscles to your heel bone. By lengthening the tendon, this surgery allows for a greater range of motion in the ankle joint, helping the foot sit properly on the ground. The goal is to correct muscle tightness and Achilles contractures or calf muscle contractures that can’t be managed with nonsurgical treatments like physical therapy or stretching.
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What Is Achilles Contracture?
Achilles contracture or calf muscle contractures occurs when the tendon becomes abnormally tight or short, preventing the heel from touching the ground. This can cause unbalanced gait, toe-walking and discomfort. Contracture may result from a range of causes, including:
- Cerebral palsy or other neuromuscular conditions
- Chronic Achilles tendinitis
- Diabetes-related deformities or clubfoot
- Spinal cord injury or stroke
- Congenital abnormalities
Typical symptoms of Achilles contracture include stiffness, poor posture, pain at the back of the foot and difficulty walking flat-footed.
Who Needs Achilles Tendon Lengthening?
Achilles tendon lengthening corrects muscle spasticity or chronic tightness that interferes with walking, standing or balance. It’s commonly recommended for patients whose Achilles contracture has not improved with stretching, bracing or physical therapy. Less commonly, this procedure is also performed to relieve pressure on the front of the foot in patients who develop ulcers due to abnormal weight distribution.
Achilles lengthening may be recommended for both children (especially those with neuromuscular conditions) and adults with chronic tendon or muscle tightness.
What Happens During Achilles Tendon Lengthening Surgery?
The surgical approach depends on the severity and cause of the tightness. Common techniques include:
- Percutaneous Lengthening: A minimally invasive approach that involves making small punctures along the tendon. These small cuts help the tendon stretch as it heals, reducing tension while maintaining strength.
- Gastrocnemius Recession: Used when tightness stems primarily from the calf muscle rather than the tendon itself. The surgeon loosens or releases part of the gastrocnemius muscle, allowing the Achilles tendon to extend naturally.
- Z-Plasty: A more controlled, open surgical method used for severe cases. The surgeon creates a Z-shaped incision in the tendon, stretches it to the desired length and reattaches it for precise adjustment and stable healing.
Most Achilles tendon lengthening surgery takes around an hour and is considered outpatient.
What Does Recovery from Achilles Tendon Lengthening Surgery Look Like?
Assuming this is done on its own and not in conjunction with other procedures, following surgery, the foot and ankle are held in a cast, boot or splint for 6–8 weeks for proper healing. Depending on the techniques used, try not to put too much weight on it during this period. Once cleared by your surgeon, you’ll start physical therapy to rebuild your strength and flexibility.
Patients can generally expect their recovery to follow something like the timeline below:
- 6–8 weeks: Initial healing period with limited mobility
- 8–12 weeks: Gradual reintroduction of weight-bearing and walking
- Several months: Full recovery and return to normal activity
Rest, ice and elevation help manage swelling and discomfort in the early stages, along with close follow-ups with your care team.
Achilles Tendon Lengthening at OrthoNebraska
Looking for Achilles tendon lengthening surgery in the Omaha area? We can help. The experts at OrthoNebraska want to make sure you feel understood, safe and confident to take on the treatment plan that’s right for you.
