A tendon is a strong, rope-like structure that connects your muscle to bone. When muscle contracts, it pulls on the tendon, which, in turn, moves the bone. The Achilles tendon, a dense band of tissue that passes behind your ankle joint, is the thickest and strongest tendon in your body, at about 6 inches long. The Achilles tendon can bear a stress load nearly 4 times your body weight while walking and almost 8 times your body weight while running. It links the calf muscles to the heel bone (calcaneus). This muscle/tendon combination produces the majority of force that pushes the foot down during walking or running. The podiatrists at Best Foot Doctor can assist you with your Achilles tendon repair.
Injuries to the Achilles tendon can vary from mild to severe: tendonitis (inflammation or irritation of the tendon), partial rupture, or complete rupture. Although the Achilles tendon can withstand great stresses from running and jumping, it is still vulnerable to injury. The rupture of a tendon is a tearing and separation of the tendon fibers so that the tendon can no longer function. Achilles tendon ruptures most commonly occur in middle-aged men, and most often while they are playing sports. People will usually describe feeling a twinge or popping the back of their calf and then a sharp pain. Achilles tendon injuries are debilitating and can cause tremendous pain.
Regaining Achilles tendon function after an injury is critical for walking. The goal of Achilles tendon repair is to reconnect the calf muscles with the heel bone to restore push-off strength.
Symptoms of Achilles tendon injury include:
- Tenderness and/or swelling around the partially injured Achilles tendon
- Bruising at the ankle
- Pain, possibly severe, near the heel
- An inability to bend your foot downward or “push off” the injured leg when you walk
- An inability to stand on your toes on the injured leg
- A snapping or “pop” sound when the injury occurs
- A palpable defect at the complete rupture
Diagnosing an Achilles tendon injury involves:
- A careful history and physical examination
- A lateral x-ray of the heel, critical for determining whether or not there is calcification of the Achilles insertion on the heel
- An MRI, helpful in determining the status of the tendon, the degree of inflammation, and whether or not the tear is partial or complete
General Details of Procedure
The surgical repair of an Achilles tendon injury typically occurs in an outpatient setting, so that the patient goes home the same day. A numbing medication is often placed into the leg around the nerves to help decrease pain after surgery. This is called a nerve block. Patients are then administered general anesthesia and positioned to allow the surgeon access to the ruptured tendon. Repair of an acute rupture typically takes between 30 minutes and one hour. Repair of a chronic rupture can take longer depending on the steps needed to fix the tendon.
There are a variety of ways to repair an Achilles tendon rupture, but the main types of surgery are:
- Open Repair: this is the most common method of surgical repair. It starts with a vertical incision made on the back of the lower leg, just above the heel bone. After the surgeon locates the two ends of the ruptured tendon, the ends are sewn together with sutures. The incision is then closed.
- Percutaneous repair: this repair method makes a small incision on the back of the lower leg at the site of the rupture. Needles with sutures attached are passed through the skin and Achilles tendon and then brought out through the small incision. The sutures are then tied together.
The best technique for your particular Achilles injury will be determined by your orthopedic foot and ankle surgeon.
After surgery, the patient is placed in a cast or splint. The patient will not be allowed to walk or put weight on the injured leg; crutches, a walker, or wheelchair are used to allow the patient to remain mobile. Patients are encouraged to keep the affected leg elevated above heart level to decrease swelling and pain.
Patients are typically seen in the office for follow-up two weeks after surgery. The cast or splint is removed and the surgical incision is evaluated. Stitches are usually removed at this time if they need to be removed at all. From 2-6 weeks, the post-operative protocol varies based on your surgeon’s judgment. Patients may be allowed to begin bearing weight in a walking boot. Moving the ankle is often allowed and encouraged.
A course of physical therapy is recommended with the goal of restoring full 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, but complete recovery may take up to a year.