Achilles Tendon Surgery
What is Achilles tendon surgery?
The Achilles tendon is the band of strong tissue that connects the calf muscle to the heel bone and is critical to walking, running, jumping or standing on tiptoe. If you hurt your Achilles tendon, either from overuse or rupture, you may need surgery to repair the problem and restore normal function and strength. Achilles tendon repair surgery involves reconstruction or replacement of the tendon. Achilles tendon surgery may also be necessary to treat foot and ankle conditions not involving direct injury to the Achilles tendon, such as plantar fasciitis.
Why is Achilles tendon surgery performed?
The goal of Achilles tendon surgery is to restore strength and proper function of the tendon. Reasons for surgery include:
Achilles tendinosis is a type of Achilles tendon injury that usually starts as tendinitis. Doctors usually recommend treating tendinitis without surgery, but it may become necessary if the condition is left untreated or doesn’t respond well to nonsurgical care. Continuous irritation and inflammation can lead to a degenerative condition called Achilles tendinosis that may require surgical repair.
Achilles tendon tear is a serious injury from forceful stretching of the tendon. This type of trauma can happen during sports or an accident. Stretching it too far can cause a partial or complete tear, which is when the tendon detaches from the heel bone. Depending on the severity of the injury, a surgeon may be able to repair the torn tendon. Sometimes the doctor will need to replace the Achilles tendon entirely using another tendon from your body.
Foot defects or deformities causing Achilles tendon problems. Conditions include Charcot foot and Hagglunds deformity.
Plantar fasciitis and heel pain not responding to self-care and other conservative measures. Releasing tension on the calf muscle and the Achilles tendon can bring symptom relief.
Surgery is most often performed on active people who want to return to their regular exercise routine and sports activities. Discuss the risks and benefits with your doctor to determine if surgery is the best treatment for you.
Who performs Achilles tendon surgery?
Podiatrists and orthopedic surgeons perform Achilles tendon surgery. A foot and ankle orthopedic surgeon specializes in musculoskeletal problems of the foot and ankle. In addition to caring for the Achilles tendon, a foot and ankle orthopedic surgeon can also diagnose and treat problems in the bones, joints, muscles, nerves and skin of the foot and ankle. A podiatrist provides medical and surgical treatment for a variety of foot and ankle problems, including Achilles tendon injuries.
When choosing a surgeon to repair an Achilles tendon injury, ask the doctor about his or her practice specialization, particularly his or her experience in performing Achilles tendon repair surgery.
How is Achilles tendon surgery performed?
Achilles tendon surgery is usually an outpatient procedure, meaning you can go home the same day. The surgery usually lasts anywhere from 30 minutes to two hours, depending on the extent of the injury. You will likely receive a general anesthetic so you are asleep throughout the surgery, but sometimes only regional anesthesia is used to numb the body from the waist down.
Types of Achilles tendon surgery include:
Gastrocnemius recession (gastroc recession), which involves lengthening the calf muscles to reduce stress on the Achilles tendon
Debridement and repair is an option when a significant portion of the tendon is intact. The surgeon removes the damaged part and repairs the rest of the tendon with stitches. If there is a bone spur causing tendinosis, the surgeon may shave it down.
Debridement with tendon transfer is performed when most of the tendon is damaged. The surgeon can replace the Achilles tendon, usually with the tendon that helps the big toe point downward.
Achilles tendon rupture surgery involves reattaching the torn ends of the tendon with stitches. Surgery may involve debridement and possibly Achilles tendon replacement with a graft (tendon transfer) if chronic damage to the tendon caused it to rupture.
Achilles tendon reconstruction or replacement for tendinosis is often an open procedure. Surgery for a torn Achilles tendon can be either an open or minimally invasive procedure. Open surgery requires a larger incision on the back of your leg above the heel, whereas minimally invasive surgery involves a smaller cut and a tiny camera to guide the surgeon through the procedure. Talk with your surgeon to determine which type of surgery is best for your situation.
What to expect the day of your Achilles tendon surgery
In general, this is what happens the day of your surgery:
A nurse will prepare you for surgery including making sure preoperative testing is complete.
A surgical team member will transport you to the operating suite and help you will lie face down on a table so the surgeon can access your Achilles tendon.
You will receive either general or regional anesthesia. Some surgeons also use a nerve block around the area to provide pain relief for 1 to 3 days after surgery.
The surgeon will make an incision in your leg above the heel or directly over the Achilles tendon to perform the necessary operation.
After the repair is complete, the surgeon will close the incision with sutures and bandage your leg.
You may need a splint, cast or boot as well as crutches, knee scooter, or wheelchair for several months to protect the area as it heals.
What are the risks and potential complications of Achilles tendon surgery?
Any kind of surgery comes with the possibility of complications, and Achilles tendon surgery also has specific risks involved.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction or breathing problems
Damage to nearby nerves or blood vessels
Blood clot, which can become life threatening
Potential complications of Achilles tendon surgery
The risks of having this surgery include:
Problems with healing, which could lead to the need for another surgery
Loss of strength in the calf muscle
Scarring of the tendon
Continued pain even after recovery from surgery
Another tear, although this is uncommon
Reducing your risk of complications
You can reduce your risk of some complications by:
Following your surgeon’s wound care guidelines and activity restrictions
Keeping your leg elevated as much as possible to reduce swelling
Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain in the ankle or calf
Taking pain medication as directed
Telling all members of your care team if you have allergies
Continue stretching exercises (after your doctor clears you to perform them) even after all symptoms have gone away
How do I prepare for Achilles tendon surgery?
Getting all your questions answered before your surgery may help you be more comfortable with the procedure and the recovery process.
Questions to ask your doctor
Questions that many people have before undergoing Achilles tendon surgery include:
How much will I hurt after the procedure?
How long will recovery take?
What’s the chance that I will still have pain in my Achilles tendon after recovery from surgery?
How likely is it that the problem will recur?
How will you treat surgical complications or continued problems after surgery?
What can I expect after Achilles tendon surgery?
Recovery time varies from person to person. How easily and quickly you recover depends on your overall health and physical fitness level, the starting condition of the tendon, and other factors. To help you know what to expect, discuss your unique circumstances with your doctor in advance of surgery if possible.
How long will it take to recover?
You may need several months before you’re able to put weight on your foot again. You will use crutches, a knee scooter, or a wheelchair in addition to a cast or boot. You might need several additional months in just a walking boot before your tendon is strong enough to bear weight on its own. Physical therapy will help restore range of motion and strength. Most people can return to their regular day-to-day activities after about six months. Full recovery and a return to competitive sports may take nine months to a year.
Will I feel pain?
You may have significant pain in your heel after surgery. Nonsteroidal anti-inflammatory drugs and sometimes opioids may be necessary to help you manage your pain. Some people may benefit from an injection of saline or numbing medication. Talk with your doctor about which type of Achilles tendon pain relief is right for you.
When should I call my doctor?
You will need to schedule an appointment with your doctor about 10 to 14 days after the procedure so the surgeon can make sure your leg is healing properly. If you experience symptoms of infection or other surgical complications, call your doctor right away. These symptoms include:
Swelling you can’t manage with self-care
Bleeding from the surgical incision(s)
How might Achilles tendon surgery affect my everyday life?
You may have some difficulty getting around for several months while your Achilles tendon heals. About 80 to 90% of people make a complete recovery from surgery. However, leg strength may always be less than it was before surgery.