Name of the Procedure:

Tenotomy, percutaneous, Achilles tendon (separate procedure); local anesthesia

Summary

A percutaneous Achilles tendon tenotomy is a minimally invasive procedure where a small incision is made to lengthen the Achilles tendon. It is commonly performed under local anesthesia to address tightness or contractures in the tendon.

Purpose

This procedure primarily addresses conditions involving tightness or shortening of the Achilles tendon, which can cause pain, difficulty walking, and limited mobility. The goal is to release the tension in the tendon, improving the range of motion and reducing discomfort.

Indications

• Chronic Achilles tendon tightness
• Congenital conditions such as clubfoot
• Conditions causing muscle contractures, such as cerebral palsy
• Pain or difficulty in walking or performing daily activities due to tendon tightness

Preparation

• Patients may be instructed to fast for a few hours prior to the procedure.
• Medications may need adjustment; specific instructions will be given by the healthcare provider.
• A thorough medical history and physical examination will be conducted.
• Imaging tests (e.g., ultrasound or MRI) may be performed to assess the tendon.

Procedure Description

1. The patient is positioned to allow easy access to the Achilles tendon.
2. Local anesthesia is administered to numb the area.
3. A small incision or a series of tiny punctures are made over the Achilles tendon.
4. Specialized instruments are used to carefully sever specific fibers of the tendon to release tension.
5. The incision is closed, usually with adhesive strips or sutures.

Duration

The procedure typically takes around 15 to 30 minutes.

Setting

This procedure is usually performed in an outpatient clinic or a surgical center.

Personnel

• Orthopedic surgeon or podiatrist
• Nursing staff
• Possibly an anesthesiologist or nurse practitioner for administering local anesthesia

Risks and Complications

• Infection at the incision site
• Bleeding or bruising
• Nerve damage
• Incomplete release of the tendon
• Tendon weakness or rupture
• Recurrence of the original problem

Benefits

• Improved range of motion
• Reduced pain and discomfort
• Enhanced ability to walk and perform daily activities
• Immediate relief in some cases, with full benefits often seen within a few weeks to months

Recovery

• Patients can often go home the same day.
• Rest and limit weight-bearing activities for several days.
• Follow wound care instructions to prevent infection.
• Physical therapy may be recommended to strengthen the tendon and improve mobility.
• Full recovery usually occurs within a few weeks to months, but gradual improvement can be expected.

Alternatives

• Conservative treatments like physical therapy and stretching exercises
• Orthotics or bracing
• Open surgical tenotomy
• Pros and cons: Conservative treatments may be less invasive but might not be as effective for severe cases. Open surgery is more invasive but allows direct visualization of the tendon.

Patient Experience

• Patients might feel mild pressure or discomfort, but pain is usually minimal due to local anesthesia.
• Post-procedure pain can be managed with over-the-counter pain relievers.
• Some swelling and bruising at the incision site are expected.
• Physical therapy will help in gaining strength and mobility in the tendon during recovery.