What is Achilles Tendon Repair Surgery?
The Achilles tendon is a strong band of fibrous tissue that connects the calf muscles in the back of the leg to the heel bone. It is the strongest tendon in the body. The Achilles tendon can tear slowly, a bit at a time, or all at once.
A ruptured Achilles may be treated with or without surgery. All treatment options require wearing a cast or boot for several weeks, followed by physical therapy for 4 – 6 months.
Surgery can lessen the time a cast or boot is needed, and you may return to activity sooner than if it was not done.
The surgical incisions and techniques can vary depending on your surgeon and your injury.
Open Achilles repair surgery is done through one incision, large enough to see the split ends of the tendon to stitch them back together.
Open repairs have the lowest risk of re-rupture, the tendon coming apart after healing. They also have the highest risk of complications related to wound healing.
Some Achilles surgeries use very small incisions. Patients have less pain and fewer problems with wound healing than with open surgery.
However, they have a higher risk of nerve injury because a nearby nerve cannot be seen when the tendon is stitched.
Achilles ruptures can heal without surgery, called non-surgical treatment. The tendon heals naturally, supported by a cast or brace for up to 12 weeks, along with physical therapy for up to 6 months.
The healing process is slower than if surgery was done.
There is no incision with non-surgical treatment, so it has the lowest risk of wound complications.
This is important for patients that are elderly, diabetic, smokers and/or those with poor circulation.
However, it has the highest risk of re-rupture compared to surgical treatments.
The Achilles to be repaired is marked while you are awake.
You will be given anesthesia to keep you free of pain during the procedure.
An incision is made along the damaged tendon.
The surgeon works carefully to reach the sheath, a protective layer around the tendon.
The sheath is opened to uncover the edges of the tendon. Torn ragged fibers are trimmed to reach strong healthy tissue, cutting away as little as possible.
The surgeon weaves sutures through the tendon fibers in a pattern designed to hold with good strength.
The sutures are tied to position and hold the tendon ends together.
The sheath is repaired. The surgical area is checked for bleeding, the skin is closed with suture, and a dressing is placed.
After surgery, “speak-up” and tell your care-team if you have unexpected pain or problems.
This will help the team identify any early rare complications.
Most achilles surgeries are outpatient, meaning you may go home the same day.
You will have some pain, bruising and swelling.
Your foot will be in a cast or boot for 6-8 weeks.
You may not be allowed to put weight on your foot for a few weeks.
You may find that anesthesia and narcotic pain medicine can cause side effects including lightheadedness, itching, nausea and severe constipation.
Also, narcotics become less effective and less useful for controlling pain after the first few days.
At home you will find it most helpful to manage pain with a combination of
- medication recommended by your surgeon,
- rest with foot elevation,
- and ice using ice-packs wrapped in a towel. Never put ice directly on your skin.
A ruptured Achilles tendon can result in a blood clot in the leg, called a DVT or deep vein thrombosis.
This is a risk of the injury whether or not you have surgery.
Certain patients are at higher risk of forming a DVT. Those include, patients on birth control pills or estrogen, those who are overweight, smokers and those with a genetic risk called Factor 5 deficiency. Steps are taken by your care team to help avoid this complication.
The most common serious problems related to this surgery are wound complications including
- tendon re-rupture,
- failure of the skin or tendon to heal, and
- adhesions, scar tissue that sticks the tendon to the skin.
The recovery process can take at least 6 months, be patient as you recuperate.
Tendons are very slow to heal and they never regain the full strength they had before rupturing.
Many repeat tears or re-ruptures are caused by accidental stress on the healing tendon that can happen by tripping, falling or returning to activity sooner than recommended.
For the best results follow your doctor’s instructions regarding rest, weight-bearing and incision care. Do not put unnecessary stress on your tendon and keep your incision clean and dry.
Make good choices to help your body heal. Eat healthy foods. Avoid junk food and sugary drinks. Don’t smoke. And keep your blood sugar under control if you are diabetic Smoking and high blood sugar both slow healing.
Call your doctor if you have a fever, worsening pain, swelling, or redness in your leg, foot or at your incision site.
Call 911 if you have chest pain, shortness of breath, dizziness, bleeding that doesn’t stop and any other sign that you may be having a complication from the procedure.
Hospital admission, medication or surgery may be needed to correct some problems.
To avoid cancellation or complications from anesthesia or your procedure, your job as the patient is to
- not eat, drink or chew gum after midnight, the night before the procedure unless you are given different instructions
- take only medications you were told to on the morning of the procedure with a sip of water
- follow instructions regarding aspirin and blood thinners before surgery,
- and arrive on time.
You should be ready to verify or confirm your list of medical problems and surgeries, all of your medications, including vitamins and supplements, your current smoking, alcohol and drug use and all allergies, especially to medications, latex and tape.
All surgery and anesthesia have a small but possible risk of serious injury, even some problems very rarely leading to death.
This video is intended as a tool to help you to better understand the procedure that you are scheduled to have or are considering. It is not intended to replace any discussion, decision making or advice of your physician