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.

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

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.

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.