Advice for parents about
elongation of achilles’ tendon
What is elongation of achilles’ tendon and why does my child/young person
need this operation?
This operation is normally performed to lengthen your child’s/young person’s achilles’ tendon. It is
performed if the achilles’ tendon is too tight, making your child/young person walk on tiptoe or
unable to place their heel on the floor when standing/walking.
One or 2 small cuts are made at the base of the leg, just above the ankle. These will be about 1 2 cm long. The tendon is then split, divided and sewn into position. The cut is closed with stitches
that dissolve whilst the plaster is on.
What are the benefits of my child/young person having this operation?
The achilles’ tendon is made longer so your child/young person can walk normally and place
his/her feet on the floor.
What are the risks, consequences and alternatives associated with my
child/young person having this operation?
Most operations are straightforward; however, as with any surgical procedure, there is a chance of
side-effects or complications:
There is a 5% risk of infection in the wound
There is a 5 - 10% risk of the ankle joint bending upwards, causing difficulty with your
child/young person putting the foot to the floor
There is a 10% risk of the foot returning to the position it was in before the operation
If you are concerned about these risks, or have any further queries, please speak to your
child’s/young person’s consultant.
Your child’s/young person’s consultant has recommended this procedure as being the best option.
There are no alternative procedures/treatment available.
However, there is always the option of your child/young person not receiving any treatment at all.
The consequences of your child/young person not receiving any treatment will depend on their
condition and the need for this operation.
If you would like more information, please speak to your child’s/young person’s consultant or one
of the nurses caring for your child/young person.
Getting ready for the operation
You will be informed of your child’s/young person’s pre-assessment appointment and your
child’s/young person’s date of surgery (usually 2 - 3 weeks before the date of admission).
It is necessary to attend a pre-assessment appointment (which is usually a week before the
date of admission).
This visit is necessary to ensure that your child/young person is prepared for theatre. Here you
will be given information regarding the operation and admission.
You will also have the opportunity to ask any questions, whilst familiarising yourself and your
child/young person with the hospital. Verbal and written fasting instructions will be given to you.
You will be asked to sign a form giving consent to your child’s/young person’s surgery at the
outpatient appointment and to confirm consent on the day of the operation.
The surgeon will give you opportunity at this time, to ask any further questions.
If your child/young person feels unwell a few days before the operation, please telephone the
Sunflower Ward (details are at the end of this information sheet).
What sort of anaesthetic will my child/young person be given?
When your child/young person comes in for their operation, a consultant anaesthetist (who is a
qualified medical doctor with specific specialist training in anaesthesia) will give the anaesthetic.
The anaesthetist will review the general health of your child/young person and discuss with you
and your child/young person the anaesthetic care plan.
If your child/young person has any specific problems, please inform the anaesthetist at this
stage. If you have any questions or concerns, please raise them with the anaesthetist.
Your child/young person will be given a local anaesthetic cream on the back of their hands in
order to reduce much of the discomfort caused by the anaesthetic injection.
Sometimes your child/young person may be sent off to sleep by encouraging him/her to breathe
a mixture of gases instead of an injection.
It usually takes a little longer but the breathing method is just as safe and very useful,
particularly if your child/young person is very agitated about injections.
You are always welcome to accompany your child/young person into the anaesthetic room
while he/she is going off to sleep.
Modern anaesthetics are very safe and, after the operation, your child/young person will wake
up in the recovery room where a qualified member of staff will look after him/her.
Once your child/young person has woken up sufficiently and is comfortable, he/she will be
brought back to the ward to be with you.
Further painkillers will be given if required and in most cases, your child/young person will be
encouraged to drink as soon as he/she feels like it.
What should we expect after the operation?
Some discomfort is usual for the first day or so, but this is not severe and will soon settle.
Your child/young person will return from theatre with a plaster cast on his/her leg. The cast will
be from the knee down and will also cover the foot, so that it is held at a 90% angle to the leg.
This will ensure that when the plaster is taken off, your child/young person will be able to place
the foot on the floor normally (even though this may take a lot of practice initially).
Your child/young person will need to stay in hospital for 2 - 3 days.
DISCHARGE INFORMATION AND AT HOME ADVICE
The following information is a guide to help in the care and recovery of your child/young person
at home after the operation.
Personal hygiene
As your child/young person will have a plaster cast on, he/she will be unable to have a
bath/shower, as the plaster cast must be kept dry at all times.
Plaster cast
The plaster will have to stay on for 6 - 8 weeks depending on your child’s/young person’s
doctor’s instructions.
The nurses will put a hard coating on the plaster before your child/young person is discharged
home. This will strengthen the plaster so that it will last longer.
You will be given an information sheet about the plaster cast so that you can look after it
yourself at home.
Following removal of the plaster at the hospital, your child/young person will need physiotherapy
to encourage him/her to ‘place’ their foot on the floor properly, as well as give them walking
practice.
Returning to normal activities
Your child/young person may return to school in the plaster cast one week after the operation (if
the school is able to accommodate him/her, as your child/young person will not be able to get
up and down stairs easily).
The physiotherapist and consultant will give further advice about your child’s/young person’s
return to normal activities.
Treating your child’s/young person pain after the operation
After the operation your child/young person may be sore for several days. If your child’s/young
person’s behaviour is out of character, this may be due to pain, e.g. he/she cries a lot, is very
clingy, unusually quiet or refuses to eat.
If you think your child/young person is in pain, please give the painkillers as directed.
Please be reassured that you will not overdose them if you follow these instructions, nor will
they become addicted to the medicines. It is best to give the painkillers regularly for the first
2 - 3 days after their operation and then as needed:
● Paracetamol (Calpol, Disprol)
This can be given to your child/young person regularly 4 times a day for the first 2 days
after going home, and thereafter as needed up to 4 times a day. Give amount as directed
on the bottle.
● Ibuprofen (Junior Nurofen)
Give this to your child/young person as needed up to 3 times a day. It is safe to give both
Ibuprofen and Paracetamol together, or alternate Ibuprofen with regular doses of
Paracetamol.
● If your child/young person is asthmatic, it may still be safe to give them Ibuprofen as
they may have had it in hospital. If you are worried about this, please talk to the nursing
staff or doctors before you leave. If your child’s/young person’s asthma gets worse at
home, stop using Ibuprofen, but continue with the Paracetamol as prescribed. Rarely,
Ibuprofen can cause indigestion; if this occurs, stop using it but continue with
Paracetamol. Follow the instructions on the bottle for drug dosage.
If you do not understand anything, please ask one of the nursing staff or doctors. If your
child/young person suffers a lot of pain at home that does not get better with these painkillers,
please call Sunflower Ward or your GP.
Please ensure that you have these painkillers at home
ready for your child’s/young person’s discharge.
Outpatient appointment
An outpatient appointment will be arranged for 2 weeks after the operation.
References:
‘Safety of percutaneous tendoachilles tenotomy performed under general anesthesia on infants
with idiopathic clubfoot’. Parada SA, Baird GO, Auffant RA, Tompkins BJ, Caskey PM. J Pediatr Orthop.
2009 Dec;29(8):916-9.
‘Neurovascular complications following percutaneous tendoachillis tenotomy for congenital
idiopathic clubfoot’.Changulani M, Garg N, Bruce CE. Arch Orthop Trauma Surg. 2007 Aug;
127(6):429-30. Epub 2007 Jan 10
If you have any queries or require further information, please telephone
the Sunflower Ward on 01332 786856
Call 111 for non-emergency confidential health care advice and information, 24 hours a day.
“Call 111 when it’s less urgent than 999”
Reference Code: P1045/0190/11.2013/VERSION6
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