Achilles Tendon Lengthening (ATL Surgery)

This procedure treats tendon contracture from chronic tendonitis - also known as short or contracted Achilles tendon. Cutting the Achilles tendon relieves pressure and allows it to lengthen as it heals.

What You Need To Know About Achilles Tendon Lengthening

What is Achilles Tendon Lengthening?

Achilles Tendon Lengthening elongates a contracted Achilles tendon with a small series of surgical cuts on the afflicted tendon at the back of the ankle. The tendon gains length as these cuts heal.

Achilles contracture can occur as a result of atypical foot formation. Symptoms of the condition include poor posture, muscle spasticity, and discomfort at the back of your feet. Because the procedure lengthens the tendons, it can improve your walking and posture, especially for flat-footed people.

You will need to wear a cast for at least six weeks following surgery. Some people may need doctor supervision immediately following surgery and require a brief hospital stay.

Achilles lengthening surgery should only be considered as an option after conservative treatments have been exhausted. A Resurgens physician will be able to provide you with a thorough consultation.

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Why is an Achilles Tendon Lengthening Procedure Performed?

ATL Surgery is sometimes performed to correct muscle spasticity but is primarily used to improve an inability to walk or stand due to a condition called Achilles contracture.

There is not one single explanation for Achilles contracture. However, the abnormality occurs when ankle mobility is compromised. Some associated conditions include:

  • Cerebral palsy
  • Chronic tendinitis
  • Spinal cord injury
  • Stroke
  • Genetics/birth abnormality
  • Diabetes-related deformity or clubfoot

Each person is different, and they may experience Achilles contracture differently. Common symptoms include:

  • Extensive pain in the Achilles tendon
  • Toes positioned abnormally
  • Foot remaining in a bent position causing flat foot, forcing the knees to bend
  • Back of feet experiencing discomfort
  • Poor posture
  • Stiff foot muscles otherwise called muscle spasticity

If you are experiencing these or related symptoms, schedule an appointment with a Resurgens Physician today.

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How to Prepare for an Achilles Tendon Lengthening Procedure

During your initial visit, you will undergo a series of diagnostic screenings that will help your physician determine the extent of your condition. Your doctor will decide whether or not you are a candidate for the ATL procedure. They may elect to try to correct your condition with a non-surgical conservative option before recommending surgery.

Before undergoing surgery, make sure you haven't had food or drink for at least eight hours. Tell your doctor if you are pregnant, are taking prescriptions, or have medical allergies. Mitigate potential risk due to complications by avoiding blood thinners, such as Aspirin, for ten days prior to surgery. Stop smoking at least six weeks before surgery to boost your recovery time.

Make sure you arrange for transportation after your procedure, as well as for at-home care during your recovery.

Your Resurgens doctor will be able to provide you with more thorough information.

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What Happens During an Achilles Tendon Lengthening Procedure?

There are many different approaches your Resurgens physician may take to alleviate tension on the tendon - including minimally invasive options as well as traditional open surgery. Some procedures may require a medical implant, while others will not.

There is no such thing as a typical condition. Likewise, there is no typical treatment. Primary treatment methods include:

Percutaneous Method

During this procedure, your doctor punctures the outside of the skin. This puncture creates tears in the tendon, which relieves tension on the cord. As the tendon heals, it retains length, resulting in less overall tension on the muscle.

Gastrocnemius Recession

This procedure loosens muscle fibers bound to the cord. The surgeon clips the gastrocnemius muscle (at the back of the leg), which helps elongate the tendon. It is usually for mild Achilles tension. It can be performed with an intramuscular implant, or with noninvasive endoscopic surgery.


This procedure allows for the greatest control over tendon size. A surgeon creates a Z-shapes series of cuts in the tendon and stretches it to a predetermined length. Then they join the tendon back together.

Your doctor will determine the best treatment option. Schedule an appointment with the Resurgens Foot and Ankle Center to learn more.

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Are There Risks Associated with an Achilles Lengthening Procedure?

All treatments - from open surgery to non-surgical are subject to a degree of risk. However, Resurgens physicians are field-recognized experts. Many of them have received training and are board-eligible (if not board-certified) experts in their field.

A brief overview of risks associated with ATL procedures includes:

  • Severing of the tendon during or after surgery
  • Damage may prevent blood flow to the tendon
  • Longer recovery time
  • An over lengthened tendon can create too much weight on your foot.
  • Pressure injuries can form on the time
  • The tendon may not loosen after surgery
  • Severing of the tendon during or after surgery
  • Additional surgery to correct complications

Your Resurgens Physician will be able to discuss these risks with you in more detail before your appointment.

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Post Achilles Tendon Lengthening Surgery and Recovery

Your treatment option will vary depending on the severity of your condition. Plan to wear a walking cast for at least six weeks following your surgery. Some patients will need to stay for a brief hospital visit as they recover from surgery. Additionally, you may need to attend physical therapy to help you strengthen your ankle and regain mobility.

Post-Surgery Care Instructions

  • Do not scrub the incision spot while showering
  • Avoid applying non-prescribed creams/lotions/ointments to the incision area.
  • Limit aggressive physical activity to allow the tendon to heal
  • Keep away from hot tubs, pools, and related recreation that can cause infection.
  • Refrain from putting weight on the affected foot as this can compromise the surgery.

Once the splint, cast, or boot is removed, physical therapy may be recommended for strengthening the ankle and improving mobility. If you experience intense pain or aggravate your wound, call your physician immediately.

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