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[Sean Connery]

So there are studies out there showing that stretching doesn't seem to do much in preventing equinus contracture unless it can be actively stretched for at least 6 hours per day. There are ways around this like locking the ankle as part of the fixator or using a calcaneotibial screw like so http://www.ncbi.nlm.nih.gov/pubmed/18800215 but for some reason it seems a lot of doctors don't like to do that as well.

With this information, why is it that it's not a standard procedure to either do a tendon release or one of the above methods? Sure you might get some weakness after a tendon release, but isn't that far better than needing to get surgery later to prevent equinus that won't go away? Why do so many doctors just recommend stretching or using a foot splint?

[Overdozer]

Because stretching works. Also locking the ankle in essence is the same thing as wearing a foot splint during the lengthening. Also, I'm not sure, but I've heard that some of the popular internal doctors here are indeed locking the ankle when lengthening the tibia.

[KiloKAHN]

Not sure about the screw or the ankle locks, but I know that one reason a tendon release isn't always done is that it's not always effective in preventing equinus contracture. Sometimes it still develops even after the release is done. If you get the release and still develop equinus anyway, you're going to beat yourself up for doing it.

[Medium Drink Of Water]

It's unnecessary surgery for many people, which is generally frowned upon in the medical community.

[KiloKAHN]

Just took a look at the calcaneotibial screw article. Holy christ that looks hardcore.

[123]

I did LL in Europe with a TSF and I had a screw locking my ankle, but it wasn't inserted like in that study, the screws went across my ankle not from the heel upwards. My doc told me that this is kinda important, so I think that this is pretty much a standard procedure with external frames (unless the Ilizarov-frame is used I think) in a first world country, India and China are probably still a bit behind.

[joax]

What is seen cannot be unseen.

[ChrisIsaak]

Many doctors consider fascia lata/illotibial band release (for femur lengthening) and gastrocnemius-soleus release (for tibiae lengthening) a standard procedure. The latter isn't achilles tendon lengthening. That's achillotenotomy, which I haven't seen a single doctor perform for leg lengthening.

[KrP1]

This foto is  not of the achilles lengthening surgery? because Oh my God . It looks so bad

[Time4LL]

That is not achilles Tendon lengthening surgery! Something must have gone very wrong there!

[ItsMyLife]

well paley said that sometimes whe external foot splint isnt available when u do not use ilizarov, then we have a distal screw at the ankle. so, the best option is always extenral foot splint

[KiloKAHN]

This foto is  not of the achilles lengthening surgery? because Oh my God . It looks so bad

No, it's what the article calls an extraarticular calcaneotibial screw. They put it in as one of the ways of preventing equinus contracture by forcing the foot to remain at a neutral position during the whole lengthening process.