Tight Heel Cord (Equinus)
The tight heel cord is one of the root causes of many mechanically related foot and ankle conditions. A contracted Achilles tendon can be congenital or acquired in nature and is called equinus contracture. An equinus condition can place incredible stress on the foot causing eventual breakdown of joints that can lead to acquired flatfeet and rupture or stretching of soft tissue supports in the arch. In the diabetic it can even lead to forefoot ulcers. Heel pain, stress fractures, ball of foot pain, mechanical arthritis all can often be attributed to equinus contracture.
In mild to moderate cases the tight heel cord can be monitored and controlled with conservative treatments. Heel cord stretching and orthotics and supportive shoes are often recommended to control the associated symptoms.
In more severe cases, the tight heel cord often requires some form of surgical heel cord lengthening. This procedure often considered key to some reconstruction strategies especially in flatfoot surgery. There are several techniques for lengthening which can take place near the level of the insertion (tendoachilles lengthening) or at the tendon muscle interface (gastrocnemius recession).
While lengthening of the Achilles tendon can be very beneficial in the severe contracted state, it still requires focused rehabilitation to return to full function. The lengthening is often combined with other procedures unless the disease process is identified early before any secondary tissue breakdown occurs.