TOE WALKING SURGERY (Achilles Tendon Lengthening)
ACHILLES TENDON LENGTHENING SURGERY FOR TOE WALKING
What Is Achilles Tendon Lengthening Surgery?
Achilles tendon lengthening surgery is a procedure designed to extend the Achilles tendon, enabling children to walk with their knees straight and feet flat on the ground. This surgery is commonly employed to rectify toe walking in young patients who have not responded positively to conservative treatments.
Generally, this surgery is considered only after other non-invasive methods, such as physical therapy, bracing, and other conservative treatments, have proven to be unsuccessful.
Does Your Child Need Surgery For Toe Walking?
Toe walking can be a concern for many parents, but how do you know if your child needs surgery?
Dr. Mikkel Jarman explains the criteria used to determine whether surgical intervention is necessary for toe walking in children.
Dr. Jarman outlines the key factors he considers: the age of the child, the results of the Silfverskiold test, and the effectiveness of conservative care. He explains why children over the age of 7-8 years are more likely to require surgery and how a clinical assessment like the Silfverskiold test helps diagnose the underlying causes of toe walking.
Achilles Tendon Lengthening (ATL) Surgery Process with Dr. Jarman
Dr Jarman's Toe Walking Surgery Process
Pre-Surgery Consultation:
The surgical process begins with a telehealth appointment to discuss your child’s specific situation and to determine their eligibility for surgical intervention. The day before surgery, an office visit is required for a thorough workup to confirm the child’s candidacy for the procedure.
Day of Surgery:
On the day of the surgery, patients need to arrive at the surgical center an hour before the procedure. The surgery is performed, and a cast is applied to protect the surgical site. Typically, patients can leave about an hour after the surgery. A mandatory two-week follow-up is scheduled to remove the initial cast, check the site, and apply a new cast with a special modification for easy removal at home.
Post-Surgery Care:
Around week four, the child transitions into a walking boot for two weeks. By week seven, an office staff member will call to discuss proper expectations as the child moves out of the walking boot and into regular shoes. Surgery is performed on one leg at a time, with the second leg typically scheduled 2.5 months after the initial surgery. The same procedure and follow-up process are followed for the second leg. Physical therapy is strongly recommended starting approximately six weeks after surgery, with a final telehealth follow-up scheduled six months after the initial surgery to confirm the child’s progress and graduation from the program.
Dr Jarman's Explains ATL Surgery
Achilles Tendon Lengthening is a surgical procedure performed when conservative treatments for toe walking fail. Dr. Jarman, with over a decade of experience, routinely performs this surgery every Wednesday. This procedure involves lengthening the Achilles tendon to allow for normal foot positioning and gait.
When Conservative Treatment Has Failed
Many children who persistently toe walk, despite trying numerous conservative treatments, often have an underlying anatomical variation in their lower legs that can only be addressed through surgery.
In this video, we follow the journey of our 8-year-old patient who faced this issue and underwent Achilles tendon lengthening surgery. We provide a comprehensive overview of the entire process, from the initial diagnosis to the remarkable results achieved after surgery.
More Toe Walking Surgery Success Stories
Follow the journey alongside these patients who have undergone toe-walking surgery. Delve deeper into their unique experiences and gain comprehensive insight into the surgical procedure.
What is Idiopathic Toe Walking?
Idiopathic Toe Walking (ITW) is a condition in which children over the age of three continue to walk on their toes while showing no evidence of neurological, orthopaedic, or psychological disorders. The National Library of Medicine says ITW effects 7 to 24 percent of children.
Children who walk on their toes for an extended period of time are putting an inordinate amount of stress on their knees, hips, and lower back bones and ligaments. Children are at risk of injury and joint discomfort as they become older if their bones develop wrongly or their ligaments are overstretched as a result of ITW.
Toe-walking can be caused by conditions like cerebral palsy, a tight Achilles tendon from birth, or diseases that make muscles weak, like Duchenne Muscular Dystrophy. Toe-walking may be linked to developmental disorders like autism or other myopathic or neuropathic disorders.
Physical therapy to gently stretch the Achilles tendon and calf muscles, splints or leg braces to promote a normal gait, or a series of casts to progressively relocate the toes toward the shin are all treatment options if we decide that a physical condition is affecting toe walking.
Without medical assistance, the majority of youngsters quit toe walking on their own. For those who don’t, ITW is treated with physical therapy, bracing, and casting, with surgical options available if these approaches fail.
When Does a Child Need Achilles Tendon Lengthening Surgery?
Achilles tendon lengthening (ATL) corrects a tight or contracted tendon. The Achilles tendon connect the heel bone to the calf muscles. Every time your child moves his or her foot – walking, running, jumping, or just pointing their toes – they use their Achilles tendon. When the tendon is too tight, it may cause pain and problems walking. This often manifests as toe walking.
Although toe walking is very common, especially when children first learn how to walk, it may indicate an issue. One of these is a too-short Achilles tendon.
Other issues that may require Achilles tendon
lengthening surgery include:
- Birth defect or deformity, e.g. clubfoot and congenital vertical talus (CVT)
- Cerebral palsy
- Chronic tendinitis
The pediatric podiatrist almost always pursues conservative (non-surgical) treatment first. This may include physical therapy exercises, leg braces, a splint, or below-the-knee casting. If conservative treatment fails, your doctor may then discuss ATL surgery with you.
How Is Achilles Tendon Lengthening Surgery Performed?
ATL surgery requires a general anesthesia. From there, the surgery varies according to the extent of your child’s particular issue. ATL surgery options include:
- Z-plasty: This is the most common method, utilizing z-shaped incisions in the tendon to stretch it before sewing the tendon back into place
- Percutaneous: Uses small incisions that allow the podiatric surgeon to elongate the tendon via tiny cuts
- Gastrocnemius recession: Lengthens and loosens the fibers of the gastrocnemius muscle in the calf
The surgeon then closes the incisions. The same day, your child receives a walking cast.
What Are the Risks of Achilles Tendon Lengthening Surgery?
All surgery carries some level of risk. The most common risks with ATL surgery are infection, pain, swelling, and nerve damage.
If your child experiences any of the following symptoms, call your doctor right away. If you can’t reach your podiatrist, seek emergency medical care.
- Chest pain or shortness of breath
- Fever over 101
- Pain that doesn’t respond to medication
- Extremities that feel cold or appear pale or purple
- Bleeding or pus draining near the incision
- Skin discoloration near the incision
- Numbness in the fingers or toes
- Increased swelling
- Dehydration (signs include lack of tears when crying, fewer than 6-8 diapers per day, dry mouth, chapped lips, yellow urine, constipation)
- Excessive diarrhea or vomiting
What Happens After Achilles Tendon Lengthening Surgery?
The full recovery time takes between 3 and 6 months, depending on your child’s unique circumstances. Always follow your doctor’s instructions. The following is general advice to help you understand what to expect.
Your child leaves the surgery center with a cast on, which remains for four weeks, with no walking allowed during this period. After the cast is removed, they will wear a boot for 2 weeks and be partial weight bearing (PWB) at that time. They will likely have a prescription for pain medication, which may include ibuprofen, Tylenol, or something stronger if indicated. Follow your doctor’s instructions exactly when administering pain medication. If a prescription-strength medication includes Tylenol, never give your child additional Tylenol in between doses.
Nausea is a common side effect, particularly as the anesthesia wears off. This feeling may last for 24 hours. During this time, stick to a diet of clear liquids and foods that are easy to digest. Avoid heavy or greasy foods. If your child vomits, avoid any foods or liquids for 30 to 60 minutes.
Have your child rest the leg as much as possible for the first 48 hours, keeping it elevated. Pillows work well for this. It’s also helpful for them to wiggle their toes occasionally to help prevent swelling.
When to Talk to a Pediatric Podiatrist about Achilles Tendon Lengthening Surgery
If your child continues toe walking past age 3, particularly if they have one of the conditions listed above, schedule an appointment with Pediatric Foot & Ankle. Dr. Jarman will examine your child and explain all of your treatment options.
Considering Toe Walking Surgery for Your Child?
At Pediatric Foot & Ankle, Dr. Mikkel Jarman offers expert care for children experiencing toe walking. While over 90% of cases can be treated conservatively, surgery may be necessary in some instances.
While this procedure is often covered by insurance. Out-of-state plans may not offer this benefit.
Dr. Jarman's ABFAS Certification
Dr. Mikkel Jarman, DPM, FACFAS, has received his Foot and Reconstructive Rearfoot/Ankle (RRA) Surgery board certification from the American Board of Foot and Ankle Surgery (ABFAS). This certification symbolizes the highest level of expertise that can be achieved in the foot and ankle profession, reflecting advanced proficiency and knowledge.
Your Child's Feet Are Designed For Life
