Achilles Tendon Surgery: Everything You Need to Know

 Achilles Tendon Surgery: Everything You Need to Know

Your Achilles tendon helps you walk, jump, and run, so injury to it can be quite debilitating. Treatment for an Achilles tear or Achilles rupture may include surgical intervention to fix damage to this fibrous connective tissue, helping restore its function and integrity. While some total tendon ruptures can heal without surgery, Achilles tendon repair surgery lowers the risk of a recurrent tear when compared to non-surgical therapy.
What Is Achilles Tendon Repair Surgery?

Surgery for Achilles tendon repair involves mending the ends of a torn or ruptured tendon. Sometimes this involves replacing a section of a severely damaged tendon by transfer of a tendon from elsewhere in the foot.2

An achilles tendon repair is usually done as a scheduled procedure for chronic tears or after the swelling from an acutely ruptured tendon has gone down. It is usually done as soon as a few days after the injury, and if not, then within a few weeks of it at most.3

This procedure can be done with an open approach or with a minimally invasive percutaneous approach that relies on small surgical tools equipped with a camera.4 The surgery is performed by an orthopedic surgeon.

Regional anesthesia (spinal anesthesia) or a nerve block are the usual pain control methods used.5 This means that you will be awake and your pain control will only affect your foot and leg. Local anesthesia may be used as well.

Achilles tendon repair surgery isn't the right solution for everyone.

Extensive tearing of a tendon might not be repairable. Chronic tendon damage may result in scarring and shortening of the tendon, which can make it difficult for the ends of the torn tendon to be placed in the right position for reattachment.

And if you have a major illness or substantial muscle atrophy (shrinking), you might not be able to participate in postoperative exercises that you need to do to recover, which increases the risk of post-surgical scarring and stiffness. This may make the procedure ill-advised.

Surgical repair of a sudden rupture is generally considered more likely to be effective than repair of an older tear because a newly ripped tendon is usually still healthy enough and long enough for the ends to be attached.1
Potential Risks

This surgery can cause complications that are normally associated with anesthesia and surgery. Specifically, Achilles tendon repair surgery poses the risk of an injury during the surgery, potentially resulting in excessive bleeding or nerve damage. Nerve damage can cause prolonged sensory issues or weakness of the leg or foot.

Achilles tendon repair surgery can also be complicated by a post-operative foot infection, impaired wound healing, or impaired healing of the tendon. You would have a higher risk of these issues if you have diabetes or if you're a smoker.

Delayed risks include decreased foot mobility and foot stiffness due to post-surgical scarring.

There is a risk of a repeat tendon tear after an Achilles tendon repair surgery, even if your surgery is successful.
Purpose of Achilles Tendon Repair Surgery

You might consider having Achilles tendon repair surgery if you have had a total or partial Achilles tendon tear or rupture. This can occur suddenly due to a sports injury or trauma (you might hear a "pop" sound), or it can develop gradually due to repetitive motion.

This type of injury can be diagnosed with a physical examination and non-invasive imaging tests, like a magnetic resonance imaging (MRI) test of your foot. A torn Achilles tendon can cause pain, weakness, and swelling of the foot, so adequate treatment is necessary.

If you have a small tear that is likely to heal without surgery, your doctor might recommend conservative management such as resting your foot or wearing a cast or brace for several months so the tendon can heal on its own.

However, if the structures of the ripped tendon are not positioned where they could heal properly or the tear is large, it is unlikely to heal on its own.

Because chronic tears might not be easily repaired with surgery, you and your doctor will have to discuss the pros and cons of nonsurgical treatment versus surgery even if you haven't tried conservative management yet.

Sometimes it isn't possible to predict whether conservative management will be effective.
Achilles Tendon Pain
How to Prepare

If you experience a sudden traumatic Achilles tendon rupture, you may have swelling that could interfere with the surgical repair. Your doctor might schedule your repair a few days or a week after your injury to maximize your chances of improvement.

You might have imaging tests for surgical planning, such as an X-ray or MRI of your foot and leg. Additionally, you will have some preoperative testing, including a complete blood count (CBC) and a blood chemistry panel.

An Achilles tendon repair surgery is a scheduled outpatient procedure done in an operating room located in a hospital or surgery center. It is rare to have this procedure immediately after going to the emergency room for an injury.3
What to Wear

You can wear anything comfortable for your surgery appointment. You should wear flat shoes and socks that can easily be removed.

On your way home after surgery, you will have a cast or boot on your surgical foot; you can wear a regular shoe on your other foot.
Food and Drink

You won't have to make any dietary changes for your Achilles tendon repair surgery.

Your surgeon may adjust some of your regular medications before you have surgery, including blood thinners and anti-inflammatory medications.
What to Bring

When you go to your surgery appointment, it's important that you bring a form of personal identification with you, your health insurance information, and a method of payment for any portion of your surgery that you are required to pay.

Because the surgery is on your foot, you won't be able to drive, so be sure to have someone who can take you home after the procedure.
Pre-Op Lifestyle Changes

Prior to your surgery, you will need to rest your foot to avoid additional injury and help reduce the swelling. This is especially important if you are having surgery for a recent traumatic Achilles tendon rupture.
What to Expect on the Day of Surgery

When you go to your surgery appointment, you will sign in and fill out consent forms. You will then go to a pre-operative area to change into a surgical gown.

Your temperature will be checked, and your pulse, oxygen level, and blood pressure will be monitored. You will have an intravenous (IV, in a vein) line placed before you head to the surgical suite or operating room where you will have your surgery.

Your surgeon will likely see you and examine your foot before your surgery.
Before the Surgery

Your leg will be covered with a drape, and the area where your incision will be placed will be exposed. Your team will clean your foot with a surgical disinfecting cleanser. If you are going to have a tendon transfer, any other area of skin that needs an incision will be cleaned at this time as well.

You will have the anesthetic medication injected near your spinal nerve to reduce movement and sensation. Alternatively, you might have a nerve block, with anesthetic injected into the sciatic nerve or femoral nerve.5 You may have the medication injected with a needle that is removed, or your anesthesiologist might leave a catheter in place so your medication can be gradually injected during your surgery.

Sometimes, local anesthesia can be used as well, with anesthetic medication injected near the surgical site.

Your doctors will test your sensation to ensure that you can't feel any pain or pressure before your surgery is started.
During the Surgery

Your surgeon will begin your surgery by making an incision along the back of your ankle. Usually, the skin incision is made just to the side of the midline so shoes will not rub on the site of the scar.

Your incision might be several inches long if you are having an open repair, or it can be less than an inch in length if you are having a percutaneous repair. Sometimes a percutaneous repair involves more than one small incision.

You will also have a layer of fascia (connective tissue) cut so your surgeon can access the tendon.

Your surgical team will be able to directly visualize the torn ends of your Achilles tendon if you are having an open procedure. If you are having percutaneous surgery, the torn ends of your tendon are located using the camera-equipped surgical device that is placed into your incision.4

Strong sutures are placed at both ends of the torn tendon to hold it together. These sutures are then tied together to repair the tissue.

Repair is optimized with the following methods:

Your surgeon will not stretch either end of your torn tendon too much to avoid tears from occurring during or after your surgery.
Generally, the sutures are placed in a strong section of the tendon that won't be ripped by the suture, rather than a frayed or otherwise delicate edge.2

If you need to have a tendon transfer, you will have a section of healthy tendon removed (usually from your foot) and sutured to the torn part of your Achilles tendon to lengthen and/or widen it for repair.

Once your tendon repair is complete, the fascia that was cut will be repaired with sutures, and your surgical device will be removed if you had a percutaneous procedure. Your skin incision will be sutured closed as well.

You will have bandages and surgical dressing placed on your wound. Anesthetic will be discontinued and your anesthesia catheter (if you have one) will be removed.

A cast or brace will be placed on your foot either before you leave the operating room or once you get to the recovery area.
After the Surgery

Your medical team will ask you if you are having any pain after your procedure. You will receive pain medication as needed.

They will also check your foot to make sure you don't have bruising or swelling.

You should receive instructions about wound care, when its OK to place weight on your foot, and when to see your doctor for a follow-up appointment.

Your recovery starts with healing, wound care, and a period resting your foot. You will likely need to wear a cast or a removable boot for four weeks. Rehabilitation begins after several weeks of foot immobility and continues for several months.

Your own recovery schedule is based on the size of your incision, the severity of your tendon tear, and your surgeon's overall assessment of your progress in healing.

You will have several appointments with your doctor throughout this phase. Your sutures will be removed and your dressing changed. You will be given direction regarding how and when you can advance your activity and place light pressure on your foot; this usually takes a few weeks.6

During the healing phase after your surgery, the key goals are to protect your wound and to identify early complications. You will need to make sure that you keep your wound clean and dry as instructed by your medical team, and that you change the dressing based on the instructions you were given.

It's also important that you don't stretch or place pressure on your healing tendon.

Signs of complications include:

Warmth near your surgical site
Streaks of red on your skin near your cast or dressing
Oozing of fluid or pus

If you develop any of these issues, be sure to call your surgeon's office.
How to Know If Something Is Wrong With Your Cast
Coping With Recovery

Your foot will be immobilized starting in a pointed position, which helps keep the previously torn ends of the tendon together. Over time, the foot is gradually flexed under the guidance of your physician.

With this and mobility restrictions, you won't be able to drive for several weeks and you may need to use crutches. To make this time more manageable, ask family and friends with help getting to appointments, grocery shopping, and so on. You may also want to ask for help make modifications to your home, such as moving furniture, to make it easier to get around.
Long-Term Care

You will need to participate in physical therapy and rehabilitation after your surgery. This involves exercises to strengthen the muscles in your calf and foot, as well as to improve your range of motion.

Your surgeon and physical therapist will give you a schedule. Starting therapy too soon can prevent healing, and delaying therapy can lead to muscle atrophy and joint stiffness from lack of use.6
Exercises for Recovery After an Achilles Tendon Tear
Possible Future Surgeries

You shouldn't need any follow-up surgical procedures after having an Achille's tendon repair operation. However, even with adequately healed repairs, there is a risk of recurrent tearing.

If you have another tear, you and your doctor will consider your likelihood of improving with conservative management or another surgery.
Lifestyle Adjustments

While staying active is highly beneficial for your health, it's important that you are aware of the risks of further injuries. You can try to prevent getting injured by wearing the right shoes for the activities you're doing and aiming for moderate and consistent activity, rather than infrequent high-intensity exercise.
A Word From Verywell

An Achilles tendon repair surgery is a procedure that's considered more definitive and long-lasting than non-surgical management of an Achilles tendon rupture or tear. You may want to consider your other options if you've had an injury of your Achille's tendon, but keep in mind that this procedure is considered effective and relatively low risk.

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