Heel cord advancement combined with Vulpius' lengthening of the gastrocnemius

The results of Achilles tendon lengthening to treat spastic pes equinus deformity are less than satisfactory, with high recurrence rates. To improve the outcome, heel cord advancement can be done. In the current study, the patients with severe contracture of the Achilles tendon were treated by heel cord advancement. Additional lengthening of the gastrocnemius muscle using the Vulpius technique was done to reattach the Achilles tendon to the calcaneus. Seventeen patients (20 feet) with spastic pes equinus deformities were treated with this technique, and satisfactory midterm postoperative results were obtained. The mean age of the patients at surgery was 10 years, and the mean duration of followup after surgery was 8 years. The mean tibioplantar angle decreased postoperatively, and there were no recurrences of pes equinus deformity and no appearance of pes calcaneus deformity. Walking ability improved in two patients and did not deteriorate in any of the patients. Seven of the patients were able to stand on only the affected foot after the operation. Our technique provides good correction of an equinus deformity with no recurrence, and with improvement of the physical activity level.