Abstract
Background
Lack of ankle dorsiflexion secondary to a tight gastrocnemius-soleus complex is believed to be a contributing factor in forefoot pain particularly metatarsalgia. It is believed that by lengthening the gastroc-soleus complex weight is distributed more evenly over the foot reducing symptoms. However lengthening any tendon, especially using a percutaneous method carries risks of over-lengthening. In the summer of 2008 we started to see some patients who complained of significant weakness in their Achilles tendons following the 3 cut percutaneous tenotomy procedure.
Method
All patients who underwent a percutaneous tendo-achilles release performed between June 2007 and October 2008 were identified through the clinical coding department and theatre log books. Their clinical notes were reviewed until discharge. Patients who were diabetic or had a foot deformity secondary to neurological complications were excluded.
Results
40 percutaneous tendo-achilles releases were performed in 38 patients, with an average age of 51 (male:female ratio 5:33). 37 were performed in combination with forefoot procedure. 36 were mobilized full weight bearing in a heel weight bearing shoe post operatively, of which 8 developed symptomatic over lengthening of the Achilles tendon at a mean of 7 months (2-15) post-operatively. Of these 7 required surgical treatment in the form of Achilles shortening.
Conclusion
We no longer perform percutaneous Achilles tendon lengthening in neurologically normal patients, due to our concern regarding the risk of over lengthening. We now prefer to perform an open gastrocnemius lengthening.
