Comparison of Percutaneous Achilles Tendon Lengthening and Open Z-Plasty in Children with Idiopathic Achilles Tendon Contracture

Background: Achilles tendon contracture is a prevalent issue in pediatric populations, often leading to complications such as toe walking and limited ankle dorsiflexion. This study aims to compare the clinical outcomes of two surgical techniques for Achilles tendon lengthening—conventional percutaneous lengthening and Z-plasty—in children with idiopathic Achilles tendon contracture, while assessing the adequacy of a six-week postoperative immobilization period. Methods: A retrospective analysis was conducted on 60 pediatric patients (ages 5–17) who underwent Achilles tendon lengthening at our institution between 2021 and 2025. Patients were divided into two groups: 25 receiving percutaneous lengthening and 35 undergoing Z-plasty. Inclusion criteria encompassed idiopathic contracture with a follow-up of over 12 months. Outcomes measured included ankle dorsiflexion, time to resume normal activities, length of hospital stay, duration of cast immobilization, complications, the likelihood of choosing the same treatment method again, taking analgesics, AOFAS score, and patient/guardian satisfaction. Results: Both surgical methods resulted in significant improvements in ankle dorsiflexion and functional outcomes. The percutaneous group demonstrated a mean increase of 30° in dorsiflexion, while the Z-plasty group showed a mean increase of 32.5°. The time from surgery to resuming normal activities in the Z-plasty group ranged from 6 to 11 weeks, which was significantly higher than the range of 6 to 7 weeks in the percutaneous lengthening group, p = 0.024. Guardian and patient satisfaction was high in both groups, with 94.3% of patients from the Z-plasty group and 100% of patients from the percutaneous group expressing willingness to choose the same treatment again. Four patients (11.4%) from the Z-plasty group and one patient (4%) from the percutaneous lengthening group developed complications. Conclusions: The period of cast immobilization of six weeks helped achieve good outcomes and caused few complications in children from both study groups. The conventional percutaneous approach to Achilles tendon lengthening in children helps achieve substantial correction of ankle dorsiflexion with a low risk of complications. Due to the risk of selection bias, the results should be interpreted with caution.