Toe walking is a condition that can occur in some children. It can be idiopathic or due to an underlying medical condition. Toe walking means that a child is walking on the balls of their feet while the heel isn’t touching the ground. Heel cord lengthening surgery for toe walking is the perfect solution for this problem – keep reading to learn more about this procedure.
What Is Heel Cord Lengthening Surgery?
Heel cord lengthening, or Achilles tendon lengthening procedure (ATL), is a surgical procedure that has the goal of stretching the Achilles tendon in patients whose tendon is so tight that they have to toe walk. The surgeon makes a series of small cuts in the tendon. As these incisions heal, the tendon elongates.
Are There Risks and Benefits of the Procedure?
The main benefit of this procedure is relieving the chronic pain that comes with Achilles tendon contracture. Additionally, the patient will be able to walk flat-footed without bending their knees. Standing and walking will become easier, and there is a cosmetic benefit to the procedure as well. However, there are a few risks associated with the procedure – damaging or severing the tendon during surgery, over-lengthening the tendon, or not being able to loosen it.
Who Is a Candidate for Heel Cord Lengthening Surgery?
Children under the age of 5 are recommended a non-surgical treatment for contracted Achilles tendon. This includes bracing, serial casting, physical therapy, and botox therapy. For children over the age of 5, the treatment of choice is heel cord lengthening surgery.
How Does the Procedure of Heel Cord Lengthening Surgery Go?
Achilles tendon lengthening is a surgery that’s done on an outpatient basis – this means that the child will be able to go home the same day after surgery. The child is put under anesthesia, and the surgeon can use a few different techniques, depending on the complexity of the condition. Here are the most common surgical techniques for loosening the tight Achilles tendon:
- Gastrocnemius Recession – This technique loosens the muscle fibers of the gastrocnemius muscle, and as a result, the Achilles tendon is elongated. This is used mostly for mild cases and can be done by inserting an intramuscular implant or via non-invasive endoscopic surgery.
- Percutaneous Method – With this method, the surgeon makes small stab wounds to the tendon through the skin. Punctures in the tendon lower the tension, and as they heal, the tendon becomes elongated.
- Z-Plasty – The surgeon makes a series of Z-shaped cuts in the Achilles tendon, thus enabling it to be stretched to the desired length. This procedure allows the best control over the size of the tendon.
When to Expect Results After Heel Cord Lengthening Surgery?
The results will be visible after the patient recovers from the procedure. It takes six weeks in a walking cast for that to happen, and the patient will likely require physical therapy after that. It will help strengthen the muscles, improve mobility, and also help the child learn how to walk flat-footed properly.
Talk to Your Surgeon in Miami About Heel Cord Lengthening Surgery
If you wish to learn more about this procedure, be sure to schedule an appointment with one of our doctors at Luxe Foot Surgery clinic in Miami and find out if this is the right surgery for your child. Contact us to book the free first consultation – call our office or fill out an inquiry form on our website.
How Long After Achilles Lengthening Surgery Can I Walk?
You will likely be able to walk about a week after Achilles lengthening surgery – but in a walking cast. It will take approximately six weeks to recover fully, but walking normally can be challenging for a few months.
When Is Surgery Needed for Toe Walking?
If non-surgical methods don’t bring any results, toe walking needs to be corrected surgically. This procedure is recommended for children above the age of 5.
Can You Walk After Achilles Tendon Surgery?
You can walk a week after Achilles lengthening surgery, but you will have to do it with a walking cast. It might take a few months before you are able to walk completely normally – and you might require some physical therapy.
- American Orthopaedic Foot & Ankle Society. Achilles Tendon Rupture. AOFAS website. https://www.aofas.org/footcaremd/treatments/Pages/Achilles-Tendon-Rupture.aspx. Accessed March 13, 2023.
- OrthoInfo. Achilles Tendonitis and Tendinopathy. AAOS website. https://orthoinfo.aaos.org/en/diseases–conditions/achilles-tendinitis-and-tendinopathy/. Accessed March 13, 2023.