Is there still a place for Achilles tendon lengthening?

Abstract

Patients with diabetes and ankle equinus are at particularly high risk for forefoot ulceration because of the development of high forefoot pressures. Stiffness in the triceps surae muscles and tendons are thought to be largely responsible for equinus in patients with diabetes and underpins the surgical rationale for Achilles tendon lengthening (ATL) procedures to alleviate this deformity and reduce ulcer risk. The established/traditional surgical approach is the triple hemisection along the length of the Achilles tendon. Although the percutaneous approach has been successful in achieving increases in ankle dorsiflexion >30°, the tendon rupture risk has led to some surgeons looking at alternative approaches. The gastrocnemius aponeurosis may be considered as an alternative because of the Achilles tendon's poor blood supply. ATL procedures are a balance between achieving adequate tendon lengthening and minimizing tendon rupture risk during or after surgery. After ATL surgery, the first 7 days should involve reduced loading and protected range of motion to avoid rupture, after which gradual reintroduction to loading should be encouraged to increase tendon strength. In summary, there is a moderate level of evidence to support surgical intervention for ankle joint equinus in patients with diabetes and forefoot ulceration that is non-responsive to other conservative treatments. Areas of caution for ATL procedures include the risk for overcorrection, tendon rupture and the tendon's poor blood supply. Further prospective randomized control trials are required to confirm the benefits of ATL procedures over conservative care and the most optimal anatomical sites for surgical intervention.

Tibiopedal Motion Following Tendo-Achilles Lengthening or Gastrocnemius Recession in Total Ankle Replacement: A Comparative Cohort Study

“…23,25 These procedures are not without risk as TAL may result in rupture of the Achilles tendon, whereas GR patients are at risk of losing strength in plantarflexion and nerve injury. 17,29 A comparative analysis of these procedures was performed by Jeng et al, 14 who evidenced that both TAL and GR resulted in an increase in DF, with only GR resulting in a simultaneous increase in PF. Additionally, Ruiz et al 23 reported that patients with high preoperative ROM experienced decreased ankle ROM at final follow-up (mean of 5 years), and that percutaneous TAL had no effect on ankle ROM after TAR.…”

Reporte de caso de manejo del pie traumático amputación transmetatarsiana bilateral en hospital de segundo nivel

“…18 Se puede realizar mediante una zetaplastia percutánea abierta o a través de una hemisección triple percutánea. 19 Las ventajas de esta técnica son: bajo índice de infección, curación de herida rápida y carga temprana con uso de yeso, las desventajas son las siguientes: lesión del nervio tibial anterior, del tendón flexor largo del primer dedo y del nervio sural si no se aplica la técnica adecuadamente. 20 La técnica de Barouk es eficaz en la contractura del gastrocnemio en 95%.…”

Treading on tricky ground: reconstructive approaches to Charcot neuropathic arthropathy of the foot

“…Removing a major deforming force also allows improved intraoperatory mobility and plantigrade positioning. Options include: the Hoke triple hemisection or open Z-plasty for Achilles tendon lengthening, gastrocsoleus release (Strayer technique), transection of gastrocnemius aponeurosis and soleus fascia, occasionally a peroneal longus or tibialis posterior tendon lengthening; postoperative concerns are overcorrection, rupture and poor blood supply [12,17,[26][27][28]. Claw and hammer toes require percutaneous flexor (long ± short) tenotomy procedures [29,30] extensor hallucis longus tendon Z-lengthening or metatarsophalangeal arthrodesis in the opportunity of immobile joints [14,17].…”