We have a 13 year old son who has a flat right foot with significant hyperpronation, and a very tight tendo-Achilles. He was diagnosed by a orthopeadic surgeon at Cleveland Clinic. He is supposed to have surgery sometime before he turns 16 and as stated on the medical report he is a candidate for a "tendo-Achilles lengthening, a lateral column lengthening and possible medial reefing of his posterior tibial tendon". Before surgery we will like a second (or more) opinion, but since we live overseas we are interested on names of certified doctors with ample experience on this field. Where is the best foot center? Who is more qualified, an MD or a Podiatrist? Should we wait? He is in no pain, he plays many sports very well, but his posture is just not right and appears to be worsening. We will appreciate any comments/suggestions on this matter.

Sorry to hear your son is having all these issues - and during the active teenage years! I don't know if this will help but I just had the achilles tendon surgery you asked about. I had a gastrocnemius recession (achilles tendon lengthening) and some work done on the other tendon. While I also had osteochondral defect drilling and micro-fracture, scar removal, etc done to the ankle perhaps some of my experience thus far may help...

The achilles surgery was no great picnic, but pain was controlled with medication. I started ROM and stretching exercises right away which my OS perscribed to minimize the tendon and muscle from healing and scarring in a flexed/contracted length. This was painful the first few weeks but is not too bad now (surgery was 2/16/07). I am in PT and able to weight bear in a castboot, using crutches for some support and balance. I am unable to walk far, but can ambulate around the house fine. I am currently unable to weightbear much without boot but have fair to good dorsal flexion (MUCH better than before surgery). I am pleased with results thus far and would do it again if needed {note: my OS said that if early agressive rehab and stretching are done soone after surgery then the need for a re-do is quite small}. I have a 3" incision 1/3 up the inner leg which does not bother me except for excessive adhesions/scar formation under skin. Perhaps is this just my body's reaction as I have met no one who has had this surgery. This is being worked on in PT with scar breakdown therapy no fun at all).

The tendon lengthening does not bother me now but I am unable to raise up on my toes at this time. I have been told that my calf will always be smaller and a bit weaker than my left (unoperated side). I am to spend no time in heels (I imagine not an issue for your son;) ) I am to always to be careful of an achilles rupture, but am much less likely to have this occur now that it has been lengthened. I had moderate contraction before surgey and could not reach 90 degrees dorsiflexion before surgery. From me guessing at it now, I think I can get to 90 or slightly more flexion. I find it is easier to stand and walk, although it isn't smooth or "pretty" right now. One thing I do notice is that my toes and under the balls of my feet hurt as I try to propel forword but am assured that this will stop as I gain in PT. Gait training is very important and a key part of rehabas we developed a habit of walking a certain way while contracted. Strenth training and ROM are also stressed.

I wish you and your son well. I believe this was an excellent choice of correction, at least for me and would do it again if needed.

jane