Noninsertional Achilles tendinopathy treated with gastrocnemius lengthening

Foot Ankle Int. 2011 Apr;32(4):375-9. doi: 10.3113/FAI.2011.0375.


Background: Surgery is frequently considered an option for refractory, symptomatic noninsertional Achilles tendinopathy. Gastrocnemius equinus can result in mechanical overload of the Achilles tendon and may be a factor in its etiology. Our hypothesis was that reducing load transmission to the Achilles tendon by gastrocnemius lengthening (Strayer procedure) may be an effective treatment.

Materials and methods: A prospective case series of all patients with a minimum 1-year symptomatic noninsertional Achilles tendinopathy who underwent gastrocnemius lengthening was evaluated before surgery, and at 1 and 2 years after surgery. There were 14 patients (17 tendons).

Results: One year after surgery, the median American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score was 100 points, as compared to 71 points preoperatively (p < 0.001). The median total Foot Function Index (FFI) decreased significantly from 39 to 12 points at 1 year (p < 0.001) and remained stable (12 points) at 2 years. An electronic goniometer recorded a mean gain in ankle dorsiflexion of 13 degrees. At 1 year after surgery the MRI in all eight patients (ten tendons) with a preoperative MRI demonstrated a decrease in signal hyperintensity and tendon size, signifying an improvement of the tendinopathy. At 2 years after surgery, patient satisfaction assessment revealed that all but one patient was satisfied with the result and 11 of the 14 (79%) patients were able to resume their previous sporting activities. There were no complications.

Conclusion: Gastrocnemius lengthening was an effective treatment for chronic Achilles noninsertional tendinopathy. Two-year results show good to excellent clinical outcome.

MeSH terms

  • Achilles Tendon / pathology
  • Achilles Tendon / surgery*
  • Adult
  • Female
  • Humans
  • Middle Aged
  • Muscle, Skeletal / surgery*
  • Tendinopathy / surgery*
  • Tenotomy / methods*
  • Treatment Outcome