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mahadevan
consultant foot and ankle surgeon
What is an Achilles tendon repair?
An Achilles tendon repair is an operation to repair a ruptured or torn Achilles tendon, the tendon that runs at the back of the ankle from the calf muscle to the heel bone.
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Whilst the majority of Achilles tendon ruptures can be successfully treated through functional bracing (non-surgical treatment in a specialised boot "Vacoped"), some patients may benefit from surgical repair. These include:
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Athletes who may benefit from the more reliable restoration of push-off strength and calf-muscle power and potentially an earlier return to training.
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Patents with late presentation are less likely to heal without surgery. Patients presenting beyond two to three weeks of injury and without the protection of a cast or boot have a significantly reduced potential for tendon healing.
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How is the operation done?
Admission will be made on the day of the operation. The procedure typically takes 45 to 60 minutes and is routinely performed under general anaesthesia. Occasionally a spinal anaesthetic may be considered. You will be able to return home the same day.
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The operation is performed through small incisions on the back of the ankle at the level of the Achilles tendon injury. These minimally invasive ‘keyhole’ incisions allow the tendon ends to be repaired with sutures. Occasionally a standard open approach (approximately 5cm incision) is used particularly when there is a delay since the original injury.
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The wound is closed with a dissolvable stitch. Your ankle is protected in a plaster and you will be non-weight bearing on the operated leg for two weeks. At two weeks the stitch is trimmed and your ankle is secured in a specialised boot for a further six weeks. You will be permitted to weight bear in the boot and physiotherapy will commence part-way through the boot treatment. Please click here to view your physiotherapy programme.
MRI scan of a ruptured Achilles tendon (Gold arrow showing site of rupture).
What are the surgical risks?
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Infection
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Nerve damage — causing numbness and painful scar
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Deep vein thrombosis (DVT) and pulmonary embolism (PE) – blood clots in the vein or lungs – to reduce this risk you would be prescribed blood thinners for a few weeks (unless contraindicated)
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Re-rupture of the tendon
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Prolonged swelling and stiffness
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Prolonged recovery
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Residual weakness
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It is beyond the scope of this document to list rarer risks (less than one in a thousand) but I will be very happy to discuss any worries about specific concerns and also about any family history or your past health problems. If there is anything you do not understand or if you have any questions or concerns, please feel free to discuss them with me.
Aftercare and FAQs
It is important to keep the leg elevated as much as possible especially for the first 2 weeks. Your first clinic follow-up is usually 12 to 14 days after surgery.
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Wound care – The plaster should be kept dry. At your first clinic appointment, wound inspection and suture removal would be undertaken.
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Work - If you have a sedentary job you should be able to return to work within 2 weeks (if you can arrange safe transport). If your job is physical, you may need to stay off work until the boot is removed.
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Recovery period – This procedure has a lengthy recovery and will take 12 to 18 months to achieve its maximum potential.
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Driving - You will not be able to drive for 8 to10 weeks following surgery. However, if you drive an Automatic and it was your LEFT side that was operated on; then you may start short drives 2 weeks following surgery. It is advisable to check the terms of your car insurance to ensure your cover is valid, as some policies state that you must not drive for a specific time period after an operation.
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Flying after surgery - It is generally recommended to wait at least six weeks to fly. It may be possible to fly on short-haul or domestic flights at an earlier time, but you should always check with your GP or surgeon. Always consult your doctor, your health insurance provider and the airline you are flying with before making your flight reservation.