Foot & ankle international
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Achilles tendon lengthening is an important part of the operative management of numerous foot and ankle disorders. The most commonly used percutaneous technique involves three hemitenotomies: medial, lateral, and medial. The discovery that Achilles tendon fibers may undergo external torsion created concern that improper consideration of this feature could result in fiber division insufficient to allow adequate percutaneous lengthening. Varying degrees of torsion have been reported since it was originally described. We hypothesized that torsion of the Achilles tendon does not decrease the effectiveness of a percutaneous lengthening procedure. This hypothesis was tested by comparing the medial-lateral-medial tenotomy pattern to a lateral-medial-lateral pattern. If tendon torsion affects fiber division, then asymmetrical tenotomy patterns should yield different results. ⋯ Regardless of pattern, percutaneous triple-cut Achilles tendon lengthening was effective in achieving additional dorsiflexion at roughly one-third degree per millimeter of tissue lengthening. The pattern of the Achilles tendon lengthening used and, by inference, Achilles tendon torsion had no effect on achievable dorsiflexion. One explanation is that both patterns cut all tendon fibers at least once. We concluded that a properly designed triple-cut tenotomy would be successful regardless of Achilles torsion. Percutaneous Achilles tendon lengthening also appears to be a safe procedure if care is taken to avoid the sural nerve.