Achilles lengthening, also called tendo-achilles lengthening, is a surgical procedure used to relieve abnormal tightness in the Achilles tendon, which attaches your calf muscles to your heel bone. Children with this type of tightness can develop significant walking problems. Recovery from Achilles lengthening requires a course of rehabilitation and physical therapy.
Basics
If your child has an abnormally tight Achilles tendon, she may be unable to place her foot flat on the ground. Instead, she may have to walk on her tiptoes or significantly distort the position of her knee in order to make her foot sit flat. During an Achilles lengthening procedure, your child's surgeon will reduce Achilles tightness by loosening the part of the tendon attached to the gastrocnemius calf muscle, making strategic nicks in the surface of the tendon or cutting, stretching and reattaching the tendon. Any of these approaches can improve or correct your child's foot position.
Before Cast Removal
After surgery, your child's affected leg will be placed in a below-the-knee cast for roughly three weeks. A physical therapist will help your child learn how to walk in the cast and can also provide home instruction for stretching exercises, body positioning exercises and the resumption of various daily living skills. A physical therapist can also show your child motionless exercises for his thigh and buttocks, help him perform straight leg raises and help him begin putting weight on the affected foot and leg.
After Cast Removal
After your child's cast is removed, a physical therapist can help her start performing ankle-flexing exercises, and may also use electrical stimulation to strengthen her ankle and help her re-learn proper ankle movement. In the latter stages of recovery, a therapist can also assess your child's range of ankle motion, foot alignment, ability to walk with her heel touching the ground and ankle flexibility while standing. Exercises used during this part of rehabilitation may include gait or walk training, resistance band exercises for the calf and ankle, calf stretches and exercises to improve your child's senses of balance and proprioception, or body position awareness.
Results and Considerations
Complete recovery from an Achilles lengthening procedure can take anywhere from three to six months, according to the Alfred I. duPont Hospital for Children. Your child may be able to return to school as soon as one to two weeks after surgery. If your child undergoes Achilles lengthening between the ages of 3 and 5, he has a 25- to 30-percent chance of needing an additional procedure between the ages of 9 and 12. The reason for additional surgery is typically related to growth-related changes in your child's body. Consult your child's doctor, surgeon and physical therapist for additional information.
