If we can walk with a normal gait, our Achilles tendons deserve some of the credit. These strong bundles of connective tissue give us control over our feet and posture. An overly short Achilles tendon, on the other hand, can make normal walking impossible. Fortunately, several medical procedures exist to lengthen the Achilles tendon and restore full flexibility to the foot.
The Achilles Tendon
Tendons, bands of tough, fibrous connective tissue, join bones to muscles. The Achilles tendon stretches downward from the gastrocnemius and soleus muscles in the calf and connects to the calcaneus, or heel bone. This structure gives the calf muscles control over the foot’s downward motion so a person can walk or jump. This immensely strong tendon can not only support an adult human’s body weight, it must withstand anywhere from three to 12 times that weight in extreme conditions such as athletic exertion.
A short or tight Achilles tendon may make it impossible to walk normally. The foot can make a 90-degree angle to the leg only when the knee is bent, forcing a person to walk on tiptoe. Young children who walk on their toes may have a short Achilles tendon, while poor posture, a faulty running technique or certain types of paralysis may also cause the condition in adults.
Children diagnosed with a tight Achilles tendon can undergo therapy or other procedures that may encourage the tendon to lengthen on its own. The least invasive procedure for lengthening the Achilles tendon involves bracing the foot with a device called a molded ankle foot orthosis. If this procedure fails to keep the foot in the proper alignment, causes discomfort or the child has outgrown the device without results, surgery must be performed.
Surgeries to lengthen the Achilles tendon include percutaneous tendon lengthening, Z-plasty lengthening and Gastrocnemius recession. In percutaneous lengthening, the surgeon cuts the tendon in several spots until it tears into a longer configuration. Z-plasty lengthening allows the surgeon to stretch the tendon by first making a Z-shaped cut in it. A Gastocnemius recession, which simply loosens the the muscle fibers attached to the tendon, may suffice for milder cases.
After surgery, the patient wears a cast with a sole on the bottom to enable walking. With the aid of physical therapy, patients should be able to walk in the cast after about a week, taking care to keep the cast dry and put a pillow underneath the ankle area when lying down. The cast comes off after about a month, and a brace may be applied if the patient ‘s gait has not returned to a normal. Additional physical therapy can also help the patient learn to walk properly.
While some patients may encounter minor skin infection, the possibility of accidentally over-lengthening the tendon concerns doctors most. The worst risk of this complication comes from using the percutaneous procedure, which loosens the tendon in a rather uncontrolled way. The other surgical procedures allow the surgeon much more control over the precise amount of tendon lengthening.