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Exercises and advice after calf lengthening surgery

This resource has been designed to help you remember the exercises the therapist went through with you whilst in hospital. The exercises should be done slowly and smoothly. Your child may have some pain and discomfort doing these exercises after surgery. If pain is limiting doing the exercises, then timing them around pain relief or muscle relaxant medication may be helpful. However, if pain becomes worse please seek advice from a healthcare professional and stop the exercises.

After muscle lengthening surgery it is important for the muscles to heal in their new lengthened position. In order for the surgery to be successful it is important to follow the daily program as instructed by your child’s therapist.


Supported sitting

Start by sitting your child with their leg out straight.

Help your child to sit with their back against a supported surface and their legs out straight with a small gap between their knees. They should be wearing gaiters and casts or splints. Make sure their back is supported in a comfortable position. If your child is unable to sit independently talk to your therapist about alternative ways to achieve this.

Illustration of child laid down with their legs stretched out in gaiters

Maintain this position for a minimum of 20 to 30 minutes and gradually progress duration each time.

Knee bends

Start by lying your child on their back with your child’s knee as straight as it will go.

Slowly bend your child’s knee by bringing their heel towards their bottom.

Illustration of child laid down with their knee up and their foot towards their bottom

Return to the starting position. Repeat 10 times.

How many times should we do these exercises?

Exercises should be done a minimum of 3 to 4 times a day and they should be staggered throughout the day. Any positive positions your child’s therapist has advised should be adopted whenever your child is resting. If your child is very active then you should make sure that they rest in the positive position for a minimum of 30 minutes 3 times a day and overnight.

What else can improve the outcome of my child’s surgery?

Positioning is an effective way of maintaining muscle length by holding a positive position for a prolonged period of time. The surgeon will put a cast on their legs at the end of the operation to hold their foot and ankle in a positive position. The cast is usually worn for around 4 weeks.


After the operation your child is likely to prefer to rest with their knees bent. In this position the muscles are not being stretched. You should encourage them to rest with their knees straight as much as possible.

Illustration of child laid in bed with their leg outstretched with a boot cast on up to their knee

If this is difficult for them they will be given gaiters or braces to wear on their legs which are designed to hold the legs straight to help achieve a positive position. Keeping the legs straight allows the calf muscles to heal in their new lengthened position. It is recommended to wear the gaiters as much as possible, day and night for the first 2 weeks. After this period this can be reduced to wearing gaiters at night time only. If your child is very active then encourage the use of the gaiters and braces overnight and whenever they are resting.

Do not put pillows under your child’s knees or use the bed function to allow them to bend their knees as this does not promote a positive position for healing.

Standing, walking and hydrotherapy

Children who are able to walk are encouraged to do so as soon as possible. Children who access a standing frame should start using this as soon as they can tolerate and should not stand or walk on the cast without a plaster shoe which will be provided. Once wounds have healed and the casts have been removed your child can return to or start hydrotherapy.

Illustration of child strapped into a standing frame to support their standing and walkingIllustration of child laid down with a plaster boot on their foot

Managing pain

Your child may have some pain or discomfort when wearing gaiters alongside casts or splints. Having appropriate pain and muscle relaxant medication can help manage this.

It is important to make sure there is no pressure damage by regularly checking the skin for redness or evidence of rubbing. Any red marks should disappear after 30 minutes of the gaiters being removed.

If marks do not disappear and pain continues discuss this with your child’s therapist. Increased tolerance and time wearing gaiters will increase the effectiveness of the surgery but issues around pain and skin integrity must be addressed.

What happens next?

We will contact your child’s local therapist to pass on any important information and ask them to see you at home or in school. Your therapist will review your child’s muscles length, exercises and positioning. It is important that you see your therapist once you leave the hospital so they can continue to help with your child’s exercises and rehabilitation. Your therapist can guide your child’s rehabilitation however it is your responsibility to make sure your child completes the necessary exercises. You should speak with your child’s therapist and school to make a plan for returning to school.

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Please note: this is a generic information sheet relating to care at Sheffield Children’s NHS FT. These details may not reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If this information has been translated into another language from English, efforts have been made to maintain accuracy, but there may still be some translation errors. If you are unsure about any of the guidance in this resource or have specific questions about how it relates to your child, always ask your healthcare professional for further advice.

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