The use of Percutaneous Achilles’ Tendon Lengthening as an Adjunct Procedure in Foot and Ankle Surgery: A Review

The goal of reconstructive foot and surgery for diabetic foot pathologies is to create a plantigrade foot that is braceable and has low risk of ulcer formation or recurrence. Experienced surgeons are cognizant that foot pathologies are defined in three planes: frontal, transverse and sagittal. The Achilles’ tendon is the chief deforming force in the foot along the sagittal plane [1]. For example, to improve the sagittal plane component in patients with Charcot joint disease midfoot collapse, surgeons will choose to combine their osteotomy and arthrodesis techniques with lengthening of the Achilles’ tendon [2]. In patients with significant contractures in the Achilles’ tendon, the ankle joint cannot proceed beyond ninety degrees, i.e. beyond parallel from the ground [3]. The forefoot must clear the ground in order for the gait cycle to proceed beyond forefoot loading and will utilize the subtalar joint to increase the amount of dorsiflexion the foot can achieve [4]. The abnormal utilization of the subtalar joint places significant strain on intrinsic structures within the foot, from the spring ligament to the plantar fascia.