Triceps Surae Contractures Associated With Posterior Tibial Tendon Dysfunction

Summary: Triceps surae contractures are often associated with symptomatic posterior tibial tendon dysfunction. These contractures prevent a plantigrade foot from undergoing normal ankle dorsiflexion during gait and increase biomechanical strain on the posterior tibial tendon. Achilles tendon stretching is an important component of the nonoperative management of posterior tibial tendon dysfunction. Many surgeons recommend releasing residual triceps surae contractures in the operative treatment of posterior tibial tendon dysfunction in order to decrease biomechanical strain on the reconstructed posterior tibial tendon or tendon transfer or to obtain a plantigrade hindfoot fusion. Achilles tendon lengthening can be performed through an open Z-lengthening or open or percutaneous step-cut tenotomies. In cases in which the contracture is principally in the gastrocnemius tendon, an isolated gastrocnemius lengthening procedure with or without a concurrent lengthening of the soleus aponeurosis is preferred.