Achilles Tendon Repair

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.

Post - operative period following Achilles Tendon Repair

When you wake after your operation, you will have a complete plaster on up to the knee. This will include the foot, and you will notice that the foot is pointing slightly down. You may be kept in hospital for one night after the operation, and should the plaster feel tight or uncomfortable during this time, you must let the nurses know so this can be split to give the leg some breathing space.

This does NOT compromise the operation.

After the surgery, the surgeon and the nursing staff will be able to explain to you what has been done, and you will often be discharged home the same night or early the next morning. It is not always necessary to see the surgeon following the surgery but if you request this it can of course be arranged.

Two weeks following the operation, you will be seen in the outpatient clinic, where your plaster will be removed and the wounds checked. Should these be healthy at this point, you will go into a walking boot with several wedges in the heel. Your exact post-operative course will be determined by the nature of the surgery.

Primary Repair

If a primary repair was performed, after two weeks you will go into a walking boot with three wedges. You will be able to take one wedge out every five days following your surgery, until the foot is flat inside the boot. This will take approximately fifteen days or two weeks. You will then walk for two further weeks in the boot, building the strength up in the rest of your leg, before it is safe to come out of the boot. At this point, you will be able to get the leg wet when taking it out of the boot, but must have the boot on for walking. This will take you up to the six week post-operation point, when you will the surgeon again and a programme of physiotherapy will be arranged to build the strength up in the muscles and to allow you to walk out of the boot.

Secondary Reconstruction

Sometimes at the time of surgery, it is difficult to repair the Achilles tendon ends primarily, and a reconstruction is required. This may involve division of the muscle fascia higher up (this is the gristly bit within the muscle) to allow the ends to come together, or augmentation of the repair with a tendon taken from the toe. Either way, this requires a longer rehabilitation than a primary repair. It is usual to stay in plaster for up to four weeks following this surgery, and for six weeks in the boot. Again you will have three wedges in the boot, but one of these would be removed every one week to ten days as per your surgeon’s instructions, and then the remainder of the time would be spent in the boot walking with the foot flat. Again during the time, once the wound is healthy and healed, you will be able to take the boot off for bathing and indeed at night for sleeping. Once you come out of the boot, again physiotherapy will be instigated.

Important reminders

It is important to remember that both of these operations require a prolonged recovery period with the physiotherapy once the plaster is off, and strength is not returned to normal for at least six months.

It is also worth knowing in the early stages that should you feel any pain around the wound, we would like to check this early in case there is any infection, and should the leg become suddenly more swollen and not go down overnight, we would be concerned about blood clots, and again early contact should be made with the surgeon’s secretary to arrange to be seen as soon as possible. Although the risk of blood clots is low with foot and ankle surgery, it is slightly higher with Achilles tendon repair.

Should you have any concerns in the post-operative period or simply wish to clarify your instructions, please do not hesitate to contact the surgeon’s secretary at any time.