The correct answer is:
The physical examination shows that he can get to only 5 degrees ankle dorsiflexion with knee extension, and during stance he has mild increased knee extension on the left compared to the right, and at the ankle during stance he gets very little dorsiflexion. These are definate indicators that he needs some increased length at the ankle plantar flexors, however a myofascial lengthening maybe better than a full open Z-plasty of the tendon achilles. This would be favored if he can come to neutral dorsiflexion with knee extension while he is under anesthesia. Care must be taken to avoid over lengthening of the achilles tendon.
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