What is achilles tendon repair surgery?

There are two types of surgery to repair a ruptured Achilles tendon :

• In open surgery, the surgeon makes a single large incision in the back of the leg.
• In percutaneous surgery, the surgeon makes several small incisions rather than one large one.

In both types of surgery, the surgeon sews the tendon back together through the incision(s). Surgery may be delayed for about a week after the rupture. This delay lets the swelling go down.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover. Sleep with your sore leg raised. Your doctor will tell you how to keep your leg and foot in the correct position. Keep your leg raised (such as on a pillow) as much as possible for the first few days.
• You will need to wear a cast or walking boot that keeps your foot and ankle from moving for 6 to 12 weeks after surgery.
• You can use crutches to move around the house to do daily tasks. Do not put weight on your leg without these until your doctor says it is okay.
• You may shower 24 to 48 hours after surgery, if your doctor okays it. When you shower, keep your bandage and incision dry by taping a sheet of plastic to cover them. It might be best to get a shower stool to sit on. If you have a brace, only take it off if your doctor says it is okay.
• If your doctor does not want you to shower or remove your brace, you can take a sponge bath.
• Do not take a bath, swim, use a hot tub, or soak your leg until your doctor says it is okay.
• You can drive when you can move and control your foot and ankle, you are no longer using crutches, and you are no longer taking prescription pain medicine. This usually takes 4 to 6 weeks.
• How soon you can return to your work depends on your job. If you sit at work, you may be able to go back in 1 to 2 weeks. But if you are on your feet at work, it may take 6 to 8 weeks. If you are very physically active in your job, it may take 3 to 6 months.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt. Drink plenty of fluids.
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

• Your doctor will tell you if and when you can restart your medicines. The doctor will also give you instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Be safe with medicines. Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.

Incision care

• If you have a bandage over your incision, keep the bandage clean and dry. Follow your doctor's instructions. Your doctor will probably want you to leave the bandage on until you are seen in the office. If your doctor allows it, you may be able to remove the bandage 48 to 72 hours after your surgery.
• If you have strips of tape on the incision, leave the tape on for a week or until it falls off. Keep the area clean and dry.
• If you have a splint or cast, follow your doctor's instructions. Keep it dry. Do not put anything, including powder, between the splint or cast and your skin.

Exercise

• Exercise in a rehab program is an important part of your treatment. Your first exercises will help you regain flexibility. They may also keep scar tissue from forming around the tendon.

Ice and elevation

• Most people like to use ice on the sore area after a procedure or surgery. Find out what your doctor recommends.
• Prop up the sore leg on a pillow when you ice it or anytime you sit or lie down for 3 days after surgery. Try to keep it above the level of your heart. This will help reduce swelling.
• If your doctor gave you support stockings, wear them as long as instructed.

Both open and percutaneous surgeries are successful. More than 80 out of 100 people who have surgery for an Achilles tendon rupture are able to return to all the activities they did before the injury, including returning to sports.

It's sometimes hard to know how surgeries compare. That's because the ages and activities of people having the surgeries differ. The success of your surgery can depend on:

• Your surgeon's experience.
• The type of surgery you have.
• How bad the tendon damage is.
• How soon after rupture the surgery is done.
• How soon your rehabilitation program starts after surgery.
• How well you follow your rehab program.

Talk to your surgeon about their surgical experience and success rate with the technique that would best treat your condition.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• You may need to shower or bathe with a special soap the night before and the morning of your surgery. The soap contains chlorhexidine. It reduces the amount of bacteria on your skin that could cause an infection after surgery.
• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

The risks of Achilles tendon surgery include:

• Skin infection at the incision site.
• Normal complications of surgery or anesthesia, such as bleeding and side effects from medicines.
• Nerve damage.
• Risk of repeat Achilles rupture. This risk, though, is typically less than the risk after nonsurgical treatment.
• The possibility that the healed tendon will not be as strong as before the injury.
• Decreased range of motion.

Infection is possible with any surgery, but it may be more common with open surgery than with percutaneous surgery. The small risk of other complications is about the same with either open or percutaneous surgery. And most problems go away over time. These complications include pain, delayed wound healing, nerve damage, and problems with scarring.

After either open or percutaneous surgery, you will likely wear a cast, walking boot, or similar device for 6 to 12 weeks. At first, the cast or boot is positioned to keep the foot pointed downward as the tendon heals. The cast or boot is then adjusted gradually to put the foot in a neutral position (not pointing up or down). Many health professionals recommend starting movement and weight-bearing exercises early, before the cast or boot comes off. Your total recovery time will probably be as long as 6 months.

Achilles tendon repair reconnects the ends of the broken tendon so that you can use your foot again in a normal way. You may have had one of two types of surgery. In open surgery, the doctor makes a cut (incision) at the back of your leg. In percutaneous (say "per-kyoo-TAY-nee-us") surgery, the doctor uses several smaller cuts. Tools for fixing the tendon are inserted through the cuts.

You will feel tired for several days. Your lower leg and ankle will be swollen. You may have numbness around the cut (incision) on the back of your leg. Your ankle and shin may be bruised. You can put ice on the area to reduce swelling. It should be better in a few days.

Your tendon will slowly get stronger as you recover. You will need to wear a cast or a walking boot for 6 to 12 weeks after surgery. At first, it may be set to keep your foot pointed downward as the tendon heals. You may be able to put weight on your affected leg after a few weeks. But it will be several months before you have complete use of your leg and ankle. You will need to build your strength with rehabilitation (rehab) exercises.

How soon you can return to sports or other exercise depends on how well you follow your rehab program and how well your tendon heals. Your doctor or physical therapist will give you an idea of when you can return to your activities. You may be able to return to your regular sports in about 4 to 6 months.

This surgery is done to repair an Achilles tendon that has been torn into two pieces.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no errors.
• You will be kept comfortable and safe by your anesthesia provider. The anesthesia may make you sleep. Or it may just numb the area being worked on.
• The surgery will take 1 to 2 hours.
• Your leg will be bandaged and raised. You may have a drain near your incision.
• Your foot and ankle will be held in a cast or walking boot to limit motion.