Repair of Achilles Tendon Rupture
Surgery
The surgical treatment for Achilles Tendon rupture is generally done as an outpatient procedure. You will need a general anesthetic, and you will end up with a scar of 4 – 5 inches on the back of your calf just above the heel.
When the Achilles tendon ruptures, the ends will retract and the fibers that make up the tendon are usually frayed, having a consistency like a horse's mane.
I will place stitches in the proximal and distal ends of the tendon that have retracted, bringing the ends together, and tie them in that position.
Day of Surgery
At the end of the surgical procedure the wound is covered and a short leg plaster splint is applied with the toes pointing downward (plantarflexed ankle). That dressing gives support to your ankle, holding it securely. You should leave that in place until I change it at the first post-operative office visit.
You will be given crutches at the surgery center, and I want you to not put any weight on that leg during the first week. If the splint gets wet or there is a problem with it, please call the office so I can remove it myself. Do not walk on the splint.
For things to watch for after outpatient surgery, go here.
Post-operative Course
Dealing with post-operative pain will be your major concern for the first few days.
Most people find that for the first few days after surgery their ankle will feel better if it is elevated. Generally, if you let it hang down for any period of time it will throb and you may have more swelling. You can put it into whatever position feels best, but usually that will be elevated with a pillow under the foot.
The first post-operative visit is usually 7 – 10 days after surgery. I will remove the splint and dressings, wash your leg, and take out the skin staples or stitches.
I will then apply a short leg cast from the toes to just below the knee, with the ankle again in plantarflexion. That cast is kept on for 2 weeks, and then you will return to the office to have it removed. A new cast is then applied, this time with the ankle position “brought up” as much as the tendon will allow. After an additional 2 weeks this cast is removed. Do not walk on the cast.
When it is possible to bring the ankle to neutral, with the bottom of the foot at 90 degrees to the leg, then further casting is not necessary. Instead, a CAM Walker can be used as a removable splint, and weightbearing will be allowed in the walking boot. If the ankle can not be brought to neutral, another short leg cast is applied and left in place for 2 weeks, when the repair is again assessed.
The CAM Walker must be used for protected weightbearing until 3 months after the surgery. It may be removed for bathing, when sleeping at night, and to do gentle active exercises. Sporting activities are not resumed until 6 – 9 months after surgery.
Final Results
The goal of the surgery is to leave you with a painless ankle that will allow normal activities. You should be able to regain full strength and power in the calf, and have no restriction of motion. Some patients will have some mild soreness still. Some will notice discomfort when the weather changes.
Complications
Complications can occur with any surgical procedure. Go here for a general discussion of Surgical Complications.
Specific risks of this procedure include persistence of pain, and the unusual possibility of re-rupture of the tendon.