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Achilles Tendon Lengthening

Posted by Megan E on 3/24/02 at 00:13 (077366)

My son is 9 years old and has feet so flat that they are actually rounded at the bottom. His heels just barely don't make complete contact with the floor and he has a bounce in his step and sort of walks more on his toes. This is especially obvious when bare-footed. An achilles tendon lengthening has been recommended. I just need to know more about this. He does not have CP or anything else. He rarely has pain, although he has been complaining of pain more frequently lately. The DPM explained it to me but I really need to see it in print so I can really understand. She said it is not that common, and yet, my son is the 4th patient she has seen for it this year. Can you please explain this procedure, as well as the term gastroc soleal equinus to me? Also, are there any other treatments that don't include surgery? I just want to know everything about it before I let them put my son under the knife! :o)
Thank you.

Re: Achilles Tendon Lengthening

BG CPed on 3/24/02 at 11:03 (077390)

It is a relativly simple procedure. If he has tight heel cords it makes it difficult to dorsiflex his foot ( that is pointing the toes up towards the ceiling) when you walk as the knee passes over the foot it makes it hard for the ankle to bend and the heel will pop up prematurely or bounce up and make him walk more on his forefoot.

The cord being tight can contribute to many problems one being excessive flat foot. If you cant get the range out of the ankle then many times the 'bending' motion occurs at the midfoot and arch, making it collapse. In severe cases it will make to foot look and act like the bottom of a rocking chair.

We see many children with different degree of this problem. Unfortunatly many of them have been told by the Pediatrician 'Dont worry Mom they will grow out of it' or when they become symptomatic it is falsly labeled as 'growing pains'

When many of these kids start playing a sport like soccer, basketball or trying to skate they have problems. They can trip easy, get tired faster, sore legs, shins or knees. When they skate or blade they have a bad A frame with knock knee and ankles rolling in.

There are many people that go through life with flat feet and have no problems but there are also many that do. Discovery channel had a segment on flat foot surgery. Dr Ted Hansen from Seattle had a young boy that had it. He told the parents that if it hurts the child to play and run that they may avoid activities. That in turn can make them couch potatoes or start hanging with a bad crowd. I thought it was an interesting idea and certainly plausible.

I would ask your Dr about any concerns you have, if they dont answer you in a way your satisfied then get a 2nd opinion.

Re: Thanks to BG CPed.

Megan E on 3/24/02 at 23:34 (077462)

Thank you, BG CPed for your info on the tendon lenthening. I will be calling the dr. tomorrow. Thanks again.

Re: Achilles Tendon Lengthening

Dr. Marlene Reid on 3/26/02 at 23:13 (077678)

Your son definitely need to be corrected. He needs more then the lengthening. He most likely needs an implant to help control the flatfootedness (if it is flexible) or a surgery to correct it (if it is rigid).

Re: Achilles Tendon Lengthening

BG CPed on 3/27/02 at 16:54 (077759)

Dr Reid, can you please explain the implant? I was just wondering what exactly it is and if you can go over a basic explaination of what all would be done. Not this child in particular but a pt in general with high degree of pes planus.

Did you find a pt for your seminar on the east coast? I may know of one that works out of a NovaCare facility

Re: Achilles Tendon Lengthening

Dr. Marlene Reid on 3/27/02 at 22:26 (077800)

The implant limits the abnormal motion of the subtalar joint by blocking the talar motion. It is a very simple proceedure and works best on kids aged 6-11 years old. They are back on their feet either immediately or within a few weeks, depending on the type of implant used. The idea is 1)to help stabilize the subtalar joint thereby stabilizing the rest of the foot (ie slowing down things like bunions, hammertoes, and PF) and to help the bones in the foot mature and ossify in the 'corrected' position (this only works if the patient is young enough and does not have bone maturity yet). It can be used in older kids and adults to control excess motion, provide stability and control things such as posterior tibial tendon dysfunction (PTTD).

It is ONLY for people with flexible pes planus and not a structural flat foot. The tight achilles also has to be addressed, or else it will fail. As you know, there is a catch 22 or chicken/egg relationship with equinous and flatfeet.

No, I still haven't found a PT in Vermont. I'd appreciate any leads you might have. Thanks.

Re: Achilles Tendon Lengthening

BG CPed on 3/28/02 at 06:37 (077813)

Thanks for the info, it was interesting. Would it be done in conjunction with any other procedures besides possible lengthening the heel cord? An example would be if squaring up the subtalar joint makes the first ray dorsiflexed?
I will try to get you a name of a Vermont P.T. Thanks for the info

Re: Achilles Tendon Lengthening

BG CPed on 3/24/02 at 11:03 (077390)

It is a relativly simple procedure. If he has tight heel cords it makes it difficult to dorsiflex his foot ( that is pointing the toes up towards the ceiling) when you walk as the knee passes over the foot it makes it hard for the ankle to bend and the heel will pop up prematurely or bounce up and make him walk more on his forefoot.

The cord being tight can contribute to many problems one being excessive flat foot. If you cant get the range out of the ankle then many times the 'bending' motion occurs at the midfoot and arch, making it collapse. In severe cases it will make to foot look and act like the bottom of a rocking chair.

We see many children with different degree of this problem. Unfortunatly many of them have been told by the Pediatrician 'Dont worry Mom they will grow out of it' or when they become symptomatic it is falsly labeled as 'growing pains'

When many of these kids start playing a sport like soccer, basketball or trying to skate they have problems. They can trip easy, get tired faster, sore legs, shins or knees. When they skate or blade they have a bad A frame with knock knee and ankles rolling in.

There are many people that go through life with flat feet and have no problems but there are also many that do. Discovery channel had a segment on flat foot surgery. Dr Ted Hansen from Seattle had a young boy that had it. He told the parents that if it hurts the child to play and run that they may avoid activities. That in turn can make them couch potatoes or start hanging with a bad crowd. I thought it was an interesting idea and certainly plausible.

I would ask your Dr about any concerns you have, if they dont answer you in a way your satisfied then get a 2nd opinion.

Re: Thanks to BG CPed.

Megan E on 3/24/02 at 23:34 (077462)

Thank you, BG CPed for your info on the tendon lenthening. I will be calling the dr. tomorrow. Thanks again.

Re: Achilles Tendon Lengthening

Dr. Marlene Reid on 3/26/02 at 23:13 (077678)

Your son definitely need to be corrected. He needs more then the lengthening. He most likely needs an implant to help control the flatfootedness (if it is flexible) or a surgery to correct it (if it is rigid).

Re: Achilles Tendon Lengthening

BG CPed on 3/27/02 at 16:54 (077759)

Dr Reid, can you please explain the implant? I was just wondering what exactly it is and if you can go over a basic explaination of what all would be done. Not this child in particular but a pt in general with high degree of pes planus.

Did you find a pt for your seminar on the east coast? I may know of one that works out of a NovaCare facility

Re: Achilles Tendon Lengthening

Dr. Marlene Reid on 3/27/02 at 22:26 (077800)

The implant limits the abnormal motion of the subtalar joint by blocking the talar motion. It is a very simple proceedure and works best on kids aged 6-11 years old. They are back on their feet either immediately or within a few weeks, depending on the type of implant used. The idea is 1)to help stabilize the subtalar joint thereby stabilizing the rest of the foot (ie slowing down things like bunions, hammertoes, and PF) and to help the bones in the foot mature and ossify in the 'corrected' position (this only works if the patient is young enough and does not have bone maturity yet). It can be used in older kids and adults to control excess motion, provide stability and control things such as posterior tibial tendon dysfunction (PTTD).

It is ONLY for people with flexible pes planus and not a structural flat foot. The tight achilles also has to be addressed, or else it will fail. As you know, there is a catch 22 or chicken/egg relationship with equinous and flatfeet.

No, I still haven't found a PT in Vermont. I'd appreciate any leads you might have. Thanks.

Re: Achilles Tendon Lengthening

BG CPed on 3/28/02 at 06:37 (077813)

Thanks for the info, it was interesting. Would it be done in conjunction with any other procedures besides possible lengthening the heel cord? An example would be if squaring up the subtalar joint makes the first ray dorsiflexed?
I will try to get you a name of a Vermont P.T. Thanks for the info