Achilles tendon repair/reconstruction

What is the Achilles tendon?

The achilles tendon is the largest tendon in the body. It connects the muscles of your calf to the calcaneus (heel bone). It is used when you walk, run and jump.

Although the Achilles tendon can withstand great stresses from running and jumping, it is vulnerable to injury.

achilles tendonachilles tendon



Achilles tendon rupture: What is it?

Rupture of tearing of the Achilles tendon is a common condition. This typically occurs in the unconditioned individual who sustains the rupture while playing sports, or perhaps from tripping.

There is a vigorous contraction of the muscle and the tendon tears. The patient will often describe the sensation that someone or something has hit the back of the calf muscle. Pain is suddenly present, and although it is possible to walk, it is painful and the leg is weak.

While it is possible to treat this ruptured tendon without surgery, the risk of re rupture is reduced with surgery.

The surgery is performed in order to regain the maximum strength of the Achilles, as well as the normal pushing off strength of the foot. The strength of the muscle depends on establishing the exact correct tension between the muscle and the tendon, and the only way that this can be set is by accurately repairing the tendon ends.

What does the surgery involve?

Surgery involves making a small mini incision overlying the rupture at the back of the ankle. The ruptured tendon is identified and repaired with sutures to restore the correct tension of the tendon.

Type of procedure

This is a daycase procedure and you will be discharged home the same day.

Type of anaesthesia

The operation will be undertaken under a general anaesthetic supplemented with an injection around the ankle to numb the foot (nerve block). The effect of this block will last for a few hours after surgery.

How long will the surgery take?

The surgery normally takes an hour.

Risks of surgery

Any orthopaedic surgery carries some inherent risks and it is the surgeons responsibility to fully inform you regarding the benefits and risks of this procedure. Mr Shariff will go through this in detail with you to help you make an informed decision.

This is a fairly routine procedure with risk of:

Infection:

If this occurs it is usually a superficial infection around the wound site.It settles with a course of oral antibiotics. Deep infection is rare. Overall risk is 1%.

Pins & needles or patch of numbness:

Small nerve branches which supply sensation to the skin may be bruised or cut when the skin incision is made. This may cause pins and needles or a patch of numbness around the scar or the outer aspect of the foot. This feeling generally resolves within a few weeks to a couple of months. Overall risk is 5%.

Re rupture:

There is a small risk of rerupture ( approximately 5-6%). However this risk is a little greater if nonsurgical treatment in a boot is opted for compared to surgery.

Clots - Deep vein thrombosis:

Extremely rare in foot and ankle surgery (<5%). However you will be given blood thinning injections after surgery for 4 weeks to minimise this risk.

Recovery from Surgery

What can I expect immediately after the surgery whilst in hospital?

When you wake up, it is normal to have numbness in the operated foot as the anaesthetic block will take a few hours to wear off. You will have a bulky dressing to your foot and a below knee back slab (which is half a plaster) applied. You will not be allowed to walk on the operated foot for atleast 6 weeks. The physiotherapists will make sure that you are safe on your feet before discharge and you will be provided crutches. You will also be given painkillers to take home. It is normal to experience moderate pain after surgery and you can keep this to a minimum by taking regular painkillers.

Specific recovery protocol:

Day 1 - 7

  • Ensure that you keep your foot elevated on pillows to help reduce swelling.
  • Foot wrapped in bulky bandage and below knee backslab.
  • Not allowed to put any weight through operated leg.
  • Elevate leg and take pain medication.
  • Expect numbness in foot 12-24 hours then moderate pain.
  • Do not allow foot to hang to prevent swelling.

Day 14

  • You will have a follow up visit in clinic.
  • Your wound will be inspected. You will have sutures so they will not need to be removed.
  • You will be put into a removable boot at this stage with a heel wedge.
  • Plantarflexion (downward movement) of foot is allowed.
  • You will be allowed to walk on the operated leg fully weight bearing.

2-6 weeks

  • If incision is dry, swimming is permitted at 2-3 weeks
  • Gentle exercise on bicycle permitted preferably with boot by 3 weeks
  • By 6 weeks the boot comes up to a neutral position
  • Start physical therapy under supervision as per protocol
  • Start biking without boot gradually by week 6
  • More vigorous exercise with physical therapist
  • Can discontinue boot at 8 weeks and use a shoe with a slight heel lift glued on to the sole of the shoe.


Post operative clinic visit schedule

  • 2 weeks after surgery - wound check and advice regarding basic hygiene
  • 6 weeks after surgery - clinical assessment
  • 3 months after surgery - clinical assessment and discharge

When can I begin to walk?

You are allowed to put weight on the operated leg 2 weeks after surgery, only once the wounds have healed. However it is extremely important that you ONLY walk in the boot with the heel wedges provided.

How do I look after my surgical wound site?

Your wound should be healed 2 weeks after surgery. If you notice any redness around the wound site, get in touch with your consultant as you may have a wound infection. Do not pick on any scabs and allow them to fall off.

How do I shower or wash?

Do not get your wound wet until it heals completely. You can use a waterproof cover or plastic bag over your foot when you have a shower. Only expose your wound to water after it has healed completely.

When can I get back to driving?

It is the responsibility of the driver to ensure that he/she is in control of the vehicle at all times. As a general rule, you are ready to drive when you are able to perform an emergency braking manoeuver without pain. This usually is 6 weeks after surgery.

Click here to read the guidance from the DVLA on driving after surgery

When can I get back to work?

Returning to work is very much dependent on the specific type of job and individual. As a rule of thumb -

Office based sedentary work -3 weeks
Manual labour - 16 weeks

When can I get back to sport?

It depends on the kind of exercise, but as a general rule of thumb you can get back to sports like golf 3 months after surgery.

 

 
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