Achilles Tendon Repair for an Acute Rupture
This procedure is generally performed as a day case operation. You will be coming to the day case reception lounge on the day of operation. You will be checked into preoperative lounge and will be met by the surgeon and the anaesthetist who will go through all the benefits and risks of the surgery again. Surgery is performed under general anesthetic, usually as a day case. The procedure takes approximately 30 minutes.
Technique
The operation is done with patient lying in a prone position. A 5cm incision is made along the inner side of the tendon. The torn tendon is exposed, and the 2 ends are strongly stitched together in appropriate tension.
The skin is then stitched and a below knee back slab is applied with the foot pointing downwards 20-30°.
Risks
All surgery carries potential risks. The risks are minimized by having the surgery meticulously performed by an expert in foot and ankle surgery. Risks include
- Infection - approximately 2% in our unit .
- Blood clots (thrombosis) - You will be put on Low molecular weight Heparin prophylaxis to reduce the risk of blood clots in calf, thigh or rarely in lungs.
- Numbness - can occur over the outer border of the foot, and usually improves over time
- Pain and swelling - This can occur after any foot and ankle surgery. You have to keep the limb elevated for 48 hours to avoid swelling and you will be given pain killers.
- Stiffness - this improves over time and helped by physiotherapy
- Scar sensitivity - can be improved with scar massage
- Re-rupture
Discharge advice following Achilles Tendon Repair
Dressings
In the operation theatre we will put your operated leg in a below knee back slab. This will be kept for 2 weeks until your first follow up appointment. You have to keep your plaster clean and dry.
Analgesia
You will receive a prescription for pain medication on discharge. Pain is often due to swelling, and this is eased by rest and elevation of the foot.
Walking
You should not put any weight on the leg for 2 weeks. A physiotherapist will show you how to use crutches.
Elevation
You have to keep the limb elevated to reduce the swelling. It will occur to some degree following all foot and ankle surgery. Try not to hang your leg down for two weeks after surgery. The swelling can sometime last for 6 months.
Follow-up
The first follow up is at 2 weeks. At that time we will remove your sutures and put you in a brace or plaster for further four weeks with foot gradually brought to neutral position every other week. You can start weight bearing as per your physiotherapists advice at this point. You will feel bit awkward when you start weight bearing but will be gradually get better as the plaster or brace is brought to neutral position. From 6-8 weeks we will start to mobilise the foot upward from neutral position and refer to physiotherapy for further rehabilitation exercises. You can start taking boot of the bed at this point. At 8 weeks post operatively you can discard the boot.
Driving and work
You should not drive a manual car for at least 8 weeks following surgery. After this you should start gradually, to see if you are comfortable. It normally takes a few days to feel confident. If you have an automatic car and have only had the left Achilles operated upon then you may drive after 2 weeks.
If you have an office-based job, then it may be possible for you to return after 2 weeks however it is more advisable to return after 8 weeks. If you have a more physical job, then it may take 12-16 weeks.
Recovery
It is usually possible to start light jogging after 12 weeks and return to normal sports by 6 months. The Achilles is usually thickened after surgery and while this may reduce slightly with time it is normal for it to remain slightly thicker than the other side. Therefore, this should not be a cause for concern.