Achilles Tendon Tears:
Surgery for Acute Achilles Tendon Tears:
While the concepts of surgery are straightforward, the execution is more complex. Care must be taken to ensure the tendon is repaired with the proper tension -- not too tight or too loose. The skin must be taken care of, as excessive handling of the soft tissues can cause severe problems including infection and skin necrosis. Nerves are located just adjacent to the tendon, and must be protected to prevent nerve injury.
If surgery is decided upon, it is usually performed within days or weeks of the injury. The idea is to perform the repair before scar tissue has formed, which would make the repair more difficult. Some surgeons may recommend delaying surgery a few days from the initial injury to allow swelling to subside before proceeding with the repair.
Surgery For Chronic Achilles Tendon Tears:
Several procedures can be used to add length to a chronic Achilles tear. A turndown procedure uses tissue folded down from the top of the calf to add length to the Achilles tendon. Tendon transfers from other tendons of the ankle can also be performed to help restore function of the Achilles. The results of surgery in a chronic situation are seldom as good as an acute repair. However, in some patients, these procedures can help restore function of a chronically damaged Achilles.
Infection: Infections are also problematic, and often the cause of wound healing complications.
Nerve Injury: An important nerve that provides sensation to part of the foot is next to the Achilles tendon. Injury to this nerve can cause numbness in the foot.
Re-Tear: Achilles tendon healing is not a guarantee, and the repaired tendon can be re-torn.
Rehab After Surgery:
In general, most patients return to walking in 4-6 weeks, strengthening after about 8 weeks, and exercising at 3 months. Most patients who are athletes do not return to their sport for about 6 months, and many can take longer to fully recover from Achilles surgery.
Reddy SS, et al. "Surgical Treatment for Chronic Disease and Disorders of the Achilles Tendon" J Am Acad Orthop Surg January 2009 ; 17:3-14.
Chiodo CP, et al. "Diagnosis and Treatment of Acute Achilles Tendon Rupture" J Am Acad Orthop Surg August 2010 ; 18:503-513.