Instructions for Percutaneous Tendo Achilles Lengthening
(TAL's) Surgery Patients

These instructions are intended to provide information regarding TAL surgery and the postoperative care. They address questions most frequently asked by the parents of children who are having this surgery.

  • The procedure is done as an ambulatory surgery. This means that you will come into the hospital on the day of surgery and go home later that afternoon or evening. All the children receive general anesthesia during surgery and go to the recovery room until fully awake.
  • The lengthening procedure is done by making small incisions into the muscle and tendon, through small puncture wounds on the back of the calves/heels, the muscle/tendon is continuously stretched until the appropriate length is achieved.
  • There are no "scars", the puncture sites heal well and are almost invisible by the time the casts are removed in six weeks.
  • The children are placed in short leg casts at the time of surgery; these casts will be on for up to six weeks. The children should keep their feet elevated for the first 48 hours and/or up to one week after surgery to decrease swelling and pain. They may walk on these casts and most children feel well enough to be up on their feet in three of four days.
  • Cast care includes checking the toes for swelling, color, warmth and sensitivity. Call the doctor if the toes become very swollen, change color (blue, purple), are cool to the touch or if the child complains of numbness or decreased feeling in the toes.
  • Try to keep the heels of the casts from resting continueously on the bed.  This can lead to increased pressure on the heels and skin breakdown under the cast.  Placing a pillow under the ankles and calves can help.
  • Casts must be kept dry (that may mean doing sponge baths for a few weeks). Nothing should be put down the cast to relieve itching. Using a hand held dryer on a COOL setting may help as well as medications such as Benedryl.
  • Cast shoes/boots should be worn when walking on the casts. This helps protect the casts from cracking or breaking. If the casts crack or break call the doctor so the cast can be repaired or replaced.
  • Try to keep the heels of the casts from resting continuously on the bed. This may mean putting a pillow under the ankles to decrease pressure on the heels when the child lays down or reclines.
  • Pain: There is some discomfort after surgery, therefore, you will be given a prescription for pain medicine before you leave the hospital. Most children can switch to Motrin or plain Tylenol within 4 to 7 days after surgery.
  • Children whose toe walking is not due to a neuromuscular condition will come back in six weeks to have the casts removed. Some may need physical therapy two time a week for a short period of time.
  • Children whose toe walking is due to a neuromuscular condition will be in casts for 4 weeks. Most of the children will use their braces as soon as the casts come off to help support their foot/leg. They will need more intensive physical therapy, 4-5 times a week for the first weeks, then reevaluation. Please make arrangements early with your therapist for the increased physical therapy.
  • When the casts come off, the children will initially have a "funny" gait (there may be external rotation and a flat foot appearance). It will take 6-12 weeks for the gait to improve. The parents and doctor will decide together when the child may return to sports/activities.

    Please call us if you have any questions or concerns.


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