216 May/June 2009 • Vol 99 • No 3 • Journal of the American Podiatric Medical Association Achilles tendon lengthening is an important part of the operative management of clubfoot. Classically, lengthening of the tendo Achillis by means of Z-plas- ty is performed in the sagittal plane in clubfoot. In Z- plasty (achilloplasty), the distal end of the medial half of the tendon is detached from the calcaneus, and the lateral half is divided proximally. The remain- ing ends are sutured after sufficient lengthening. 1 However, in the Achilles tenotomy (achillotomy) technique of the Ponseti method, the percutaneous tenotomy is performed transversely, approximately 1 cm above the calcaneus, under local anesthesia. 2-4 In this manner, an additional 10° to 15° of dorsiflexion is typically gained after the tenotomy. 5 The Ponseti method for the treatment of clubfoot yields better results compared with the Kite method and others. 6-9 According to Minkowitz et al, 10 the Pon- seti method has become standard for the treatment of congenital idiopathic clubfoot. Although there is much information in the literature describing the Ponseti method, there are few publications concern- ing the technique of percutaneous tendo Achillis teno- tomy in the Ponseti method for residual hindfoot equi- nus in clubfoot. 3, 11 However, percutaneous Achilles tenotomy to correct the equinus is performed in ap- Background: Tendo Achillis lengthening is performed by means of Z-plasty in the classic treatment of clubfoot. In the Ponseti method for treating clubfoot, Achilles tenotomy is per- formed percutaneously for residual equine deformity. A randomized study was designed to compare tendon healing after tenotomy versus Z-plasty. Methods: Thirty-six Sprague-Dawley rats were divided randomly into two groups. On the first day, while the right tendo Achillis of group 1 rats underwent tenotomy, those of group 2 rats underwent Z-plasty. Nine rats from each group were humanely killed on days 21 and 45 postoperatively. The two groups were compared with each other biomechanically and histologically. The Achilles tendons of eight rats in each group were evaluated bio- mechanically, and the remaining rat in each group underwent histologic evaluation. Results: Mean ± SD maximum load at rupture of the treated tendons on days 21 and 45 in the tenotomy group was 26.38 ± 7.31 N and 47.16 ± 15.36 N, respectively, and in the Z- plasty group was 27.37 ± 5.20 N and 45.27 ± 9.59 N, respectively. The biomechanical eval- uation revealed no significant difference in terms of breaking forces between the two groups. The difference between breaking forces on days 21 and 45 was statistically signifi- cant for both groups. Conclusions: Tendons in the tenotomy group healed as well as those in the Z-plasty group, and Achilles tenotomy in the rat was similar to Z-plasty for Achilles tendon lengthen- ing. Human correlation may or may not exist, but this study suggests that it should be con- sidered and investigated. (J Am Podiatr Med Assoc 99(3): 216-222, 2009) *Department of Orthopaedics and Traumatology, School of Medicine, Yuzuncu Yil University, Van, Turkey. †Department of Textile, Mustafa Cikrikcioglu School of Higher Education, Erciyes University, Kayseri, Turkey. ‡Department of Histology, Yuzuncu Yil University, Fac- ulty of Medicine, Van, Turkey. Corresponding author: Ali Dogan, MD, Department of Or- thopaedics and Traumatology, Medicine Faculty of Yuzuncu Yil University, Kazim Karabekir St, Van, Turkey 65100. (E- mail: alidogan67@hotmail.com) Biomechanical Comparison of Achilles Tenotomy and Achilloplasty Techniques in Young Rats An Experimental Study Ali Dogan, MD* Mahmut Korkmaz, BS† Nurettin Cengiz, MD‡ A. Murat Kalender, MD* M. Ata Gokalp, MD* ORIGINAL ARTICLES