33
Achilles Tendon Rupture Surgery
What is the Achilles tendon? A tendon is a strong, rope‐like structure that connects muscle to bone. When the muscle contracts, it pulls on the tendon, which in turn moves the bone. The Achilles tendon is the largest and strongest tendon in the body. It links the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus). This muscle/tendon unit produces the majority of force that pushes the foot down during walking or running. How long will I have to stay in hospital? You will come into hospital on the day of your operation and usually be discharged the same day or next morning. What happens before the operation? Prior to admission you will need to have a pre‐ operative assessment. This is an assessment of your health to make sure you are fully prepared for your admission, treatment and discharge. If you are undergoing a general anaesthetic you will be given specific instructions about when to stop eating and drinking, please follow these carefully as otherwise this may pose an anaesthetic risk and we may have to cancel your surgery. What does the operation involve? Regaining Achilles tendon function after an injury is critical for walking. The aim of Achilles tendon repair is to reconnect the calf muscles with the heel bone to restore strength. The surgical repair of an acute or chronic rupture of the Achilles tendon typically occurs as a day case. This means the patient has surgery and goes home the same day. Numbing medicine is often placed into the leg around the nerves to help decrease pain after surgery. This is called a nerve block. Patients are then put to sleep and placed in a position that allows the surgeon access to the ruptured tendon. Repair of an acute rupture often takes somewhere between 30 minutes and one hour. Repair of a chronic rupture can take longer depending on the steps needed to fix the tendon. What happens after surgery? After surgery, the patient is placed in a cast from the toes to just below the knee. Typically the patient will not be allowed to walk or put weight on the involved leg. Crutches or a wheelchair are used to allow the patient to remain mobile. Patients are encouraged to keep the operated leg elevated above heart level to decrease swelling and pain. If a nerve block has been given, patients can expect the numbing sensation to last from eight to 24 hours. Patients are typically seen in the outpatient clinic two weeks after surgery. The cast is removed and the surgical incision is evaluated. Stitches are usually removed at this time if they need to be removed at all. From two weeks to six weeks, the postoperative protocol varies based on surgeon preference. 33
At 2 weeks you will be allowed to weight bare in a boot with wedges to make you walk on tip toe. These will be gradually reduced with you walking flat over 2 weeks. You will be seen at 6 weeks post operation to start physiotherapy out of the boot. At six weeks patients are usually allowed full weightbearing out of the cast or boot. Physiotherapy is started and is aimed at restoring ankle range of motion. Strengthening of the calf muscles and Achilles is gradually allowed as the tendon heals. Patients are usually able to return to full activity by six months. It may be over a year before a patient achieves full recovery.If the surgery is a complex reconstruction the surgeon will adise on increases to these times. What are the complications of this surgery? Potential complications specific to Achilles tendon surgery include wound infection and delayed wound healing (1%). Re‐rupture can also occur (5%). There may be scarring of the tendon or thickening of the surgical scar. A nerve that gives sensation to the outside part of the foot can be stretched or injured during surgery, which can result in numbness or burning (1%). There is a small risk of a clot forming in the leg veins (Deep Venous Thrombosis or DVT) associated with any form of orthopaedic surgery. This is the same type of clot that passengers on long aeroplane flights may develop. A DVT may cause the leg to swell and occasionally the clot may break loose and lodge in the lung (Pulmonary embolism or PE). Overall the risk of a DVT or PE is small and we will take active measures to minimise this risk to you. A DVT is more likely if you are overweight or smoke. You can reduce the risk of developing a DVT by getting up and walking about as soon as possible after your operation. A DVT may only be obvious after you have gone home. If you notice any swelling of the calf or more rarely the thigh, or you experience pain or tenderness in the calf you should seek medical advice quickly. You should also contact a doctor immediately if you develop shortness of breath or pain on breathing following surgery. Achilles Tendon Rupture Surgery
Version 1
© Chesterfield Royal Hospital NHS Foundation Trust
Reviewed Date: August 2016
Next Planned Reviewed Date: August 2018
Directorate: Surgical Specialties