Noninsertional Achilles Tendinopathy Treated with Gastrocnemius Lengthening

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 nonin-sertional 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 go...