Ankle > Achilles Tendinitis > Treatments

Surgical Debridement

Preparing for Surgery

If your Achilles tendinitis pain does not subside after at least six months of conservative treatment, your physician may recommend surgery to cut away the damaged tissue and stimulate healing. If you and your physician have decided on surgery to treat your Achilles tendinitis, the decisions you make and the actions you take before your surgery can be every bit as important as the procedure itself in ensuring a healthy recovery.

   Prior to your return home from the hospital, make sure that you have received any equipment you will need when you get home. This may include crutches or household items to make movement around the house easier. You should receive prescriptions for any of these from your doctor before you go home from the hospital.

   Any physical problems or changes in your overall health, such as a fever or infection, should be reported to your surgeon, and you should notify your surgeon of any medications you are taking.

   Understand the potential risks and benefits of the surgery, and ask your surgeon any questions that will help you better understand the procedure. It can also help to talk to someone else who has undergone the same surgery.

   If possible, practice walking with your crutches so you are ready to use them after surgery.

   Getting a second opinion from another qualified surgeon is often advisable, particularly in rare or unique cases.

   To check if the orthopedist performing the surgery is board-certified or eligible, call the American Board of Orthopaedic Surgery at (919) 929-7103.


   What to ask the doctor
   What to take to the hospital

Day of Surgery [top]

At most medical centers, you will go to "patient admissions" to check in for your operation. There may be separate check-in areas for ambulatory outpatient (patients who go home the same day after surgery) and for overnight inpatient surgery, so be sure to ask your doctor or an assistant about this. After you have checked in to the hospital, you will go to a holding area where the final preparations are made. The mandatory paperwork is completed, and your ankle area may be shaved, though this is not always necessary. You will be asked to change into a hospital gown and, if applicable, remove your watch, glasses, dentures, and jewelry. You will have the opportunity to speak with your orthopedic surgeon or an assistant and meet the anesthesiologist or nurse anesthetist (a nurse who has done graduate training to provide anesthesia under the supervision of an anesthesiologist). An IV (intravenous) line may be placed in your arm at this time. Then, you will walk or ride on a stretcher to the operating room. Most patients are not sedated until they go into the operating room. Here are some important steps to remember for the day of your surgery:

   You will probably be told not to eat or drink anything after midnight on the night before your surgery. This will reduce the risk of vomiting while you are under general anesthesia.

   Since you will most likely be able to go home within a few hours of surgery, arrange for someone to drive you home when you are released.

   Wear a loose pair of shorts, sweatpants, or other clothing that will fit comfortably over your short leg cast or splint when you leave the hospital.

   Take it easy. Keeping a good frame of mind can help ease any nerves or anxiety about undergoing surgery. Distractions such as reading, watching television, chatting with visitors, or talking on the telephone can also help.


   ABC’s of anesthesia
   What to take to the hospital

Surgery Procedure [top]

Surgery to treat Achilles tendinitis usually takes about 1 1/2 hours to perform. Though the surgical debridement procedure ordinarily requires an open incision, most patients can leave the hospital the same day. Spinal anesthesia typically is given to numb you from the waist down, and you are sedated so you sleep through the procedure.

   A 5-to-10-centimeter incision usually is made in the back of your ankle, running along the inside of your Achilles tendon.

   Your surgeon cuts away, or debrides, any damaged tissue or calcium deposits. Debridement exposes healthy tissue and encourages blood flow through the damaged area to promote healing.

   You may need to have scar tissue removed from the sheath surrounding the tendon, from the tendon itself, or from a combination of both.

   If your Achilles tendon has been damaged where it inserts into heel bone, your surgeon may need to take some part of the tendon off its insertion to debride the tissue. The healthy tendon tissue is then sutured back down onto your heel bone.

   Incisions in your tendon sheath and skin are closed with stitches and your ankle is put into a splint to immobilize it. You are then taken to the recovery room.

Recovery Room  

After surgical debridement of your Achilles tendon, you will be transported to the recovery room where you will be closely observed for one to two hours while the immediate effects of anesthesia wear off. Your ankle will be immobilized in a splint or cast when you wake up, and your ankle will be elevated. After surgery, you usually experience some pain. Adequate pain medications will be prescribed for you. You will be given intravenous (IV), oral, or intramuscular pain medications as needed. Your surgeon will prescribe crutches and you are usually instructed to keep weight off your ankle for the first two weeks. Your temperature, blood pressure, and heartbeat will be monitored by a nurse who, with the help of your physician, will determine when you can prepare to go home. You will normally be able to leave the hospital or clinic within three to four hours after surgery. Make sure to have someone available to drive you home, as you will be unable to drive a car.
Home Recovery [top]

Because physicians generally recommend that you avoid putting any weight on your foot and ankle until your incision has healed, you may have to use crutches for about two weeks after surgery. Rest as much as possible with your ankle elevated above your heart level. This helps blood drain away from your ankle and can control swelling. For two or three days after surgery, most patients are instructed to stay off their feet and rest. You may be able to get around more after about three days, but you should continue to elevate your ankle as much as possible and use your crutches to keep weight off your ankle. You may need to use pain medication prescribed by your physician for one or two days after surgery. Pain usually decreases within a few days. It can be helpful to have someone around the house who can assist with any physical chores. Patients commonly return to their physician’s office within 10-14 days to have the sutures removed.


If you only had damage in your tendon sheath, your foot and ankle will probably be put into a removable brace called a cam walker, which helps relieve pain as you begin walking. A cam walker is a type of boot splint made of nylon straps that secure around your lower leg and foot to hold your ankle in place. There is usually an adjustable ankle hinge that can be set to allow some limited ankle motion. If your Achilles tendon itself was damaged, you may be put into a short leg walking cast for two to four more weeks. To keep the cast dry, either wrap a plastic garbage bag around the cast while showering or bathe with your leg out of the tub.
When the cast comes off, most patients wear a cam walker until their pain subsides. When you begin wearing a cam walker, you should remove it three times a day to perform range of motion exercises. Prop your leg up on a stool or pillow so your ankle is off the floor. Physicians generally recommend moving your ankle up, down, and side-to-side. Start with slow movements and do not move your ankle too far in any direction. Many patients can strengthen their ankles without formal physical therapy. Your physician generally evaluates your ankle after four to six weeks and determines whether regular cardiovascular exercise and everyday weight bearing can sufficiently strengthen your ankle.


   Recovery-proof your home
   When to call the doctor after surgery


Depending on how much tissue your surgeon had to remove from your Achilles tendon, you may need three to four months to strengthen the Achilles tendon until it is back to normal. Generally, patients can recover adequate ankle strength by walking around and performing some simple stretching exercises at home. However, based on how fast you improve and how much exercise you are doing on your own, your physician may refer you to a supervised physical therapy program. Athletes and people who want to return to physical activities as quickly as possible also may benefit from supervised training. A physical therapist can administer massage and heat therapy to soothe pain. However, massaging and applying heat to an injured ankle can disrupt the healing process. Your physician will decide when it is safe to begin ankle massage. Strengthening exercises usually start within a month. Initially, you will probably perform light exercises, including picking objects off the floor with your toes and flexing and extending your ankle. The resistance gradually increases as your tendon heals. You can usually return to activities when the range of motion and strength are equal in the injured and healthy ankle, when you can jog, sprint, and cut side-to-side without pain, and you can jump and land without pain.


   Achilles tendinitis rehabilitation exercises

Prevention [top]

Because overuse and overtraining puts you at high risk for recurring Achilles tendinitis, physicians generally recommend that you avoid repetitive activities that put constant strain on your Achilles tendon. If your tendinitis was caused by running or other endurance activities, you may want to cut back on your previous activity level. Try to incorporate cross-training into your workout schedule. For example, instead of running every day, alternate between running and swimming workouts. Warm up before participating in activities and stretch your calf muscles, Achilles tendons, and feet both before and after activities. You should increase the duration and intensity of your workouts by no more than 10 percent per week and avoid serious sprinting and hill climbing until you have worked up to a high fitness level. Choose athletic shoes that properly fit the shape of your foot. Continue to wear orthotic inserts and heel lifts if recommended by your physician. If your ankle starts to hurt during exercise, you should return to your physician’s office for a check-up.

Rest, Ice, Medication, Proper Footwear
Surgical Debridement
   Preparing for Surgery
   Day of Surgery
   Surgery Procedure
   Recovery Room
   Home Recovery

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