Tendon Rupture > Treatments
Open Surgical Repair
Surgery to repair a ruptured Achilles tendon can be
the best option for patients who want to return to a
high level of sports and activities. Surgical repair
can help you fully recover from a rupture with a lower
risk of re-injury.
Preparing for Surgery
If you and your physician have decided
on surgery to treat your Achilles tendon rupture, 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.
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 recommendations or prescriptions for these items
from your doctor before you go home from the hospital.
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 new medications you are taking.
understand the potential risks and benefits of the surgery,
ask your surgeon any questions that will help you better
know the procedure. It can also help to talk to someone
else who has undergone the same surgery.
possible, practice walking with your crutches so you
are ready to use them after surgery.
a second opinion from another qualified surgeon is often
advisable, particularly in rare or unique cases.
check if the orthopedist performing the surgery is board-certified
or eligible, call the American Board of Orthopaedic
Surgery at 919-929-7103.
to ask the doctor
to take to the hospital
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 outpatients (patients who go home the
day of surgery) and for overnight inpatient surgery.
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 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. You will
then 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:
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
or regional anesthesia.
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.
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.
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.
to take to the hospital
Open surgical repair of a ruptured
Achilles tendon usually takes about an hour to perform.
Though the 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 usually are sedated so you sleep through
incision about 10 centimeters long is made in the back
of your ankle, running along the inside of your Achilles
tendon, up from your heel.
surgeon opens up the sheath covering your Achilles tendon.
running stitch usually is used to weave the tendon ends
together. Two sutures are made, one along each side
of your Achilles tendon. The two sutures are tied together
to pull the ruptured ends of your tendon together.
typically gauge the tension of your Achilles tendon
in your repaired side and make it equal to the other
in your skin usually are closed with stitches and your
ankle is put into a splint to immobilize it.
are then taken to the recovery room.
After your ruptured Achilles
tendon is repaired, you will be transported to the recovery
room where you will be closely observed for one to two
hours while the immediate effects of the anesthesia
wear off. Your ankle will be immobilized in a plaster
splint when you wake up and your ankle will be elevated.
The splint usually holds your ankle in a slightly bent
downward position. 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 the doctor,
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.
Following surgery to repair
your ruptured Achilles tendon, your physician will probably
recommend that you avoid bearing weight until your incision
has healed. Crutches may be prescribed for two to four
weeks after surgery. Rest as much as possible with your
ankle elevated above the level of your heart - this
helps blood drain away from your ankle and control swelling.
Most patients are instructed to stay off their feet
and rest for the first two or three days after surgery.
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. Part of the risk
of surgery is a wound complication after your Achilles
is repaired. Though it happens in less than one percent
of patients, your ankle’s blood supply may not
be as good as other body parts and you may be prone
to wound problems. Because you cannot see your incision
inside the cast, it is important to notify your physician
if you feel discomfort. To prevent complications, your
physician checks your incision after two weeks to see
how it is healing. Over the course of six weeks, you
will return to your physician for new casts and ankle
braces until your foot is brought up to the neutral
position. Though every physician has a slightly different
way of treating Achilles tendon ruptures after surgery,
the general schedule is as follows:
weeks – Your physician removes the stitches and
you receive a new cast that immobilizes your foot in
a slightly bent-downward position.
weeks – Your physician may bring your foot up
to an almost neutral position, with your foot perpendicular
to your leg, in either a walking cast or brace, called
a cam walker. You often can begin bearing some weight
on your ankle at this time.
weeks – Begin wearing either a cam walker or supportive
shoes with an orthotic heel lift and bearing more weight
on your ankle.
Your physician may prescribe range-of-motion exercises
for you to perform at home after your cast is removed.
The goal is to avoid pain and stimulate blood flow and
circulation. Patients generally are instructed to remove
their ankle brace for a brief period and prop their
lower leg 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.
to call the doctor after surgery
After surgery to repair a ruptured Achilles tendon,
most patients are able to rebuild their ankle strength
and return to sports and activities in five or six months.
Your physician may recommend a physical therapy program
depending on how much progress you make performing range
of motion exercises on your own. You typically progress
from range of motion exercises to light cardiovascular
exercise and then strengthening
exercises. If you experience episodes of minor swelling
or pain while exercising, have your physician examine
your ankle. Physical therapy usually involves learning
stretching routine and performing foot and lower
leg strengthening exercises.
Preventing re-injury of your surgically repaired Achilles
tendon may initially require caution during sports and
activities. Your physician typically follows your progress
for about six months. If you can make it through six
months of rehabilitation without any problems, your
tendon probably has healed and you should be able to
return to a normal level of sports and activities. The
goal after surgery is to return your repaired Achilles
tendon to the strength of the uninjured side. Once you
accomplish this, risk of re-injury usually diminishes.
However, sports that require quick starts and stops,
sprinting, and jumping may increase your risk of reinjury.
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
unless 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.