Achilles Lengthening (Percutaneous) Recovery
Percutaneous Achilles Tenotomy
What the procedure does
This lengthens a tight Achilles tendon through two or three tiny cuts in the skin rather than one open incision. A fine blade makes partial cuts across the tendon at different levels, and the foot is then brought upward so the tendon slides out to a longer position. The skin punctures are so small they often need no stitches.
Why it is done
The tendon is too tight, holding the foot pointed downward so the ankle cannot bend up far enough. That loads the forefoot heavily with every step, causing pain under the ball of the foot, difficulty walking flat, and — in people with reduced sensation — ulcers that will not heal.
How it compares with an open lengthening
The result is much the same; the route differs. Small punctures mean less to heal at the skin, less scarring, and it can often be done under local anaesthetic or as a quick day case. Where the anatomy is complicated or a very precise amount of lengthening is needed, an open procedure may be preferred instead.
The main risk to understand
As with any lengthening, too much is the concern rather than too little. A tendon that ends up too long gives a weak push-off and a flat, laboured walk that is hard to reverse. The cuts are therefore made to a measured degree, and early loading is controlled.
Cast or boot
The foot is usually held in a cast or boot for several weeks with the ankle in the corrected position while the tendon heals at its new length. Your surgeon will say how much weight to put through it.
The puncture sites
There are usually two or three small marks at the back of the leg. They are tender for a few days and generally heal quickly. Keep them dry until told otherwise. Where circulation or sensation is impaired, they are watched more closely.
If this was done to heal an ulcer
Where the aim was taking pressure off a wound on the forefoot, healing that wound is the real measure of success. Offloading footwear and regular wound review usually continue alongside recovery and matter as much as the procedure did.
If you have reduced feeling in the foot
Where sensation is reduced, the usual warning signals are missing — a sore spot or blister may go unnoticed until established. Checking the foot daily, including the sole and between the toes, becomes part of the routine.
Keeping the length you gained
Once healing allows, gentle movement into the corrected position preserves the new length. This is the opposite of the caution that follows a tendon repair, and it is why the programme works ankle movement rather than protecting against it.
Calf strength
Push-off strength is reduced for some months and, depending on how much lengthening was needed, may not fully return. Strengthening later in the programme aims to recover as much as the new length allows.
Walking
Walking usually feels different afterwards — flatter, with the heel making proper contact, which is generally the point. It can take some weeks to feel natural, and unfamiliar rather than painful is expected.
Pain
Discomfort is usually modest and short-lived compared with an open operation, often settling within days. Most people need only simple pain relief.
Driving and work
Driving generally waits until you are out of the cast or boot and could perform an emergency stop confidently. Desk-based work often resumes within a week or so; work on your feet waits until out of the boot.
How the first months usually unfold
Several weeks protected in a cast or boot, then weight-bearing normalising and ankle movement worked on from around six weeks. Walking pattern generally settles between two and four months, with calf strengthening continuing beyond that.
Staying in touch with your care team
Recovery varies with why the procedure was done and with your circulation and sensation. Your own surgeon knows those details. If a wound is not healing, or you notice a new sore area on the foot, contact your care team promptly.
Exercises for Achilles Lengthening (Percutaneous)
An illustrated, phase-by-phase exercise program for this procedure. View the Achilles Lengthening (Percutaneous) exercise program.
Recovery education · Condition guides · Exercise programs
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This guide is general education and doesn't replace evaluation by a licensed provider. Recovery and treatment vary by person — follow the guidance of your own surgeon or care team.