What is Achilles tendon repair surgery?
Achilles tendon repair surgery is a type of surgery to fix a damaged Achilles tendon.
The Achilles tendon is a strong, fibrous cord in the lower leg. It connects the muscles of your calf to your heel. It’s the largest tendon in your body. It helps you walk, run, and jump.
In some cases, the Achilles tendon can tear, or rupture. This is usually due to a sudden, strong force. It can happen during tough physical activity. It can happen if you suddenly move faster or pivot on your foot. Having a foot that turns outward too much can increase your risk of a torn tendon. A ruptured Achilles tendon can cause pain and swelling near your heel. You may not be able to bend your foot downward.
The Achilles tendon can also degenerate. This is also known as tendinitis or tendinopathy. This might cause symptoms like pain and stiffness along your Achilles tendon and on the back of your heel. This is most often through overuse and repeated stress to the tendon. It can result from repeated stress on your tendon, especially if you have recently been more active. Having short calf muscles can increase your risk of tendinopathy.
During the surgery, an incision is made in the back of the calf. If the tendon is ruptured, the surgeon will stitch the tendon back together. If the tendon is degenerated, the surgeon may remove the damaged part of the tendon and repair the rest of the tendon with stitches. If there is severe damage to a lot of the tendon, the surgeon might replace part or all of your Achilles tendon. This is done with a tendon taken from another place in your foot.
In some cases, the Achilles tendon repair surgery can be done as a minimally invasive procedure. This is done with several small incisions instead of one large one. It may use a special scope with a tiny camera and a light to help do the repair.
Why might I need Achilles tendon repair surgery?
You might need Achilles tendon surgery if you tore your tendon. Surgery is advised for many cases of a ruptured Achilles tendon. But in some cases, your healthcare provider may advise other treatments first. These may include pain medicine, or a temporary cast to prevent your leg from moving. And your healthcare provider may not advise surgery if you have certain medical conditions. These include diabetes and neuropathy in your legs.
Or you may need Achilles tendon repair surgery if you have tendinopathy. But in most cases, other treatments can be used to treat tendinopathy. These include resting your foot, using ice and pain medicines, and using a brace or other device to stop your foot from moving. Physical therapy can also help. If you still have symptoms after several months, your healthcare provider might advise surgery.
Depending on the type of problem you have, Achilles tendon surgery might work for you. Talk with your healthcare provider about the risks and benefits of your choices.
What are the risks of Achilles tendon repair surgery?
Every surgery has risks. Risks of Achilles tendon repair include:
Excess bleeding
Nerve damage
Infection
Blood clot
Wound healing problems
Calf weakness
Complications from anesthesia
Continued pain in your foot and ankle
Your own risks may vary according to your age, the shape of your foot and leg muscles and tendons, your general health, and the type of surgery done. Talk to your healthcare provider about any concerns you have. He or she can tell you the risks that most apply to you.
How do I prepare for Achilles tendon repair surgery?
Talk with your healthcare provider how to prepare for your surgery. Tell your healthcare provider about all the medicines you take. This includes over-the-counter medicines such as aspirin. You may need to stop taking some medicines ahead of time, such as blood thinners. If you smoke, you’ll need to stop before your surgery. Smoking can delay healing. Talk with your healthcare provider if you need help to stop smoking.
Before your surgery, you may need imaging tests. These may include ultrasound, X-rays, or magnetic resonance imaging (MRI).
Do not eat or drink after midnight the night before your surgery. Tell your healthcare provider about any recent changes in your health, such as a fever.
You may need to plan some changes at home to help you recover. This is because you won’t be able to walk on your foot normally for a while. Plan to have someone drive you home from the hospital.
What happens during Achilles tendon repair surgery?
Achilles tendon surgery can be done with several methods. The surgery is done by an orthopedic surgeon and a team of specialized healthcare providers. Ask your healthcare provider about the details of your surgery. The surgery may take a couple of hours. During your surgery:
You may have spinal anesthesia. This is so you won’t feel anything from your waist down. You’ll also likely be given sedation. This will help you sleep through the surgery.
A healthcare provider will watch your vital signs, like your heart rate and blood pressure, during the surgery.
The surgeon will make an incision through the skin and muscle of your calf. If you have minimally invasive surgery, the surgeon will make a smaller incision. He or she may then use a tiny camera with a light to help do the surgery.
Your surgeon will make an incision through the sheath that surrounds the tendon. He or she will remove parts of your damaged tendon, or repair the rip in the tendon.
Your surgeon may remove another tendon from your foot. This is then used to replace part or all of the Achilles tendon.
Your surgeon will make any other repairs that are needed.
The healthcare provider will close the layers of skin and muscle around your calf with sutures.
What happens after Achilles tendon repair surgery?
A healthcare provider will watch you for a few hours after your surgery. When you wake up, you will likely have your ankle in a splint. This is to keep it from moving. Achilles tendon surgery is often an outpatient procedure. This means you can go home the same day.
You will have some pain after your surgery, especially in the first few days. Pain medicines will help relieve your pain. Keep your leg elevated as often as possible. This can help reduce swelling and pain. Make sure to tell your healthcare provider right away if you have a high fever or pain in your ankle or calf that gets worse. After your surgery, you will likely need to use crutches. This is so you can keep your weight off your leg.
About 10 days after your surgery, you’ll need to return to your healthcare provider to have your stitches removed. Your healthcare provider might replace your splint with a cast at this time. If so, follow all instructions about keeping your cast dry. Or, your healthcare provider may give you a special removable boot instead of a cast.
Your healthcare provider will give you instructions about when you can put weight on your leg. He or she will tell you how to strengthen your ankle and leg muscles as you recover. You may need to do physical therapy to help with your recovery.
Make sure to follow all your healthcare provider’s instructions about medicines, wound care, and exercises. This will help make sure the surgery is a success for you.
Next steps
Before you agree to the test or the procedure make sure you know:
The name of the test or procedure
The reason you are having the test or procedure
What results to expect and what they mean
The risks and benefits of the test or procedure
What the possible side effects or complications are
When and where you are to have the test or procedure
Who will do the test or procedure and what that person’s qualifications are
What would happen if you did not have the test or procedure
Any alternative tests or procedures to think about
When and how will you get the results
Who to call after the test or procedure if you have questions or problems
How much will you have to pay for the test or procedure
And Also:
Achilles Tendon Repair
Description
The Achilles Tendon connects the calf muscles to the calcaneus (heel bone) and is one of the important tendons in the human body. The main action of the achilles tendon is foot plantar flexion. Common pathologies include: tendinopathy, tear or rupture. Examples of mechanisms of injury for rupture includes: falling from a height, forceful plantar flexion of the ankle (as in jumping with an extended knee), or using the foot to break a fall if you stumble. Clinically they present with a palpable gap on palpation, increased passive dorsiflexion, lack of heel raise and a positive Thompson Test. Achilles tendon rupture is either managed conservatively with a cast or surgically with an achilles tendon repair.
Conservative vs Surgical Intervention
There is much debate in the literature about treatment for achilles tendon rupture with the two options comprising of a conservative or surgical approach. Many studies have shown that the re-rupture rates are higher in cases of non-operative management. More recently studies have demonstrated equivalent or improved rates of re-rupture compare with surgical intervention. However, many people continue to be treated with surgical repair and physiotherapists will continue to see them for post-operative rehabilitation in their clinics.
Pre-op
Prior to surgery general oedema reduction interventions should be utilised (Rest, Ice, Compression, Elevation). The surgery will ideally occur within one week of the rupture.
Surgery Description
Many techniques exist for this surgery, including transverse, medial and longitudinal incisions. The ankle is placed in neutral position and the severed ends of the tendon are sutured together. The surgeon will then take the ankle through complete range of motion to look at the integrity of the repair. A cast is often applied, with the surgical technique determining how long the cast stays on. Many surgeons are now focusing on early weight bearing and passive motion to improve tendon healing. A new minimally-invasive technique involves utilisation of the peroneus brevis via two para-midline incisions. The technique reportedly preserves skin integrity over the site most prone to breakdown in a vertical incision, open reconstruction. Another study recommended percutaneous repair in the recreational athlete and in patients concerned with cosmesis, and open repair for all high-caliber athletes who cannot afford any chance of rerupture."
Post-Op
Early mobilisation following achilles tendon repair has been reported to be beneficial in terms of postoperative recovery and improved tendon vascularity. Despite the increasing supported for accelerated rehabilitation regimes, there is still no consensus regarding the most preferable protocol.
Clinic protocols:
There's three phases of post-surgical rehabilitation following achilles tendon repair.
Phase I
Phase I typically lasts three weeks.
Goals of this phase are as follows:
Control oedema and protect the repair site
Minimise scar adhesion and detrimental effects of immobilisation
Progress to full weight bearing as tolerated/indicated
Pain 5/10 or less, strength 4/5 all lower extremity muscles except plantar flexors
Phase I interventions include:
Modalities for pain and oedema
Stretching of large lower extremity muscle groups, gastrocnemius/soleus added at week 3
AROM: plantar and dorsiflexion 3x5; 3 times daily; add inversion and eversion at week 2
Foot/ankle isometrics at week 2; band exercises week 3
Proprioceptive training for lower extremities; Gait training
Upper extremity cardiovascular exercise
Joint mobilisation and soft tissue work, as indicated
Phase II
Phase II typically lasts from post op week 4-6.
Goals for this phase are as follows:
Normalized gait pattern
Full ankle ROM
5/5 lower extremity strength
Return to full ADL ability
Pain reported to be <2/10
Proprioceptive reactions equal to non-surgical side
Phase II interventions include:
Ankle flexibility at various knee angles
Progressive closed kinetic chain lower extremity strengthening
Cardiovascular progression
Proprioceptive training on variety of surfaces
Manual resisted exercises and joint mobilization, as indicated
Phase III
Phase III typically lasts from post op week 6-15.
Goals for this phase are as follows:
Initiate running program
Improve balance and coordination
Increase velocity of activity
Return to sport
Phase III interventions include:
Progressive ankle and lower extremity strengthening
Agility exercises
Double heel raise/lower progressing to single leg heel raise at various speeds