What is Percutaneous Achilles Tendon Lengthening?

Percutaneous Achilles tendon lengthening is a minimally invasive procedure used to stretch a tight Achilles tendon and increase motion at the ankle joint.


People with a tight Achilles tendon tend to walk on their toes. The tight tendon prevents the foot from sitting flat on the floor, and can limit ankle motion. When this tightness cannot be treated with non-surgical stretching or physical therapy, your foot and ankle orthopaedic surgeon may recommend surgery.

This procedure may be only one part of a surgery to help correct the position of the foot. Patients that develop ulcers in the front part of the foot may require an Achilles lengthening to decrease pressure on the front part of the foot and allow the ulcers to heal.  

This procedure is not recommended when there is active infection or redness around the Achilles tendon. A very tight tendon may require a more complex lengthening surgery.


Percutaneous Achilles tendon lengthening may be done alone or with other procedures in order to improve the overall position of your foot. It is typically an outpatient procedure, and general or regional anesthesia is typically used. 

It only takes a few minutes for your foot and ankle orthopaedic surgeon to perform this procedure. Your surgeon makes three small incisions at the back of the ankle along the Achilles tendon. They cut the tendon approximately 50% at each of these three sites in an alternating pattern. The surgeon does this while an assistant is holding the ankle and stretching the tendon. The tendon stretches as the fibers are cut.


Healing time for tendons is approximately 6-8 weeks. You may be in a protective cast, splint, or walking boot initially while the tendon heals. Some soreness in the tendon during the first few months after surgery is common. Physical therapy and rehabilitation often are needed after the initial healing period to help with strength and range of motion. Regular Achilles tendon stretching is recommended in the long term to maintain the benefits of the surgery.

Risks and Complications

All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.

With a percutaneous Achilles tendon lengthening, complications are rare. Wound problems such as nonhealing incisions or infection can occur. The Achilles tendon can remain tight after surgery or re-tighten during the recovery period. It also is possible for the Achilles tendon to completely rupture (tear) during surgery or recovery. If the tendon completely ruptures, it is usually treated without surgery since the Achilles tendon is very good at healing itself.

Before and after percutaneous Achilles lengthening

Extent of ankle mobility before (top) and after (bottom) Achilles lengthening surgery.

When will I be able to walk again after this procedure?

If a percutaneous Achilles tendon lengthening was the only procedure performed, you will usually be allowed to put weight on your foot immediately, in a cast or walking boot. If other procedures were performed, you may need to be non-weightbearing for a number of weeks, with the amount of time depending on the procedures that were done. Generally, the Achilles tendon will take about 6-8 weeks to heal. It may take several months to be able to walk normally.


Original article by Shyler Lynn DeMill, DO
Contributors/Reviewers: Jason Tartaglione, MD; Elizabeth Cody, MD

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