Ankle > Achilles Tendon Rupture > Treatments

    Open Surgical Repair

Treatment Introduction

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.

   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 recommendations or prescriptions for these items 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 new medications you are taking.

   To 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.

   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.

RELATED TOPICS

   What to ask the doctor

   What 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:

   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 or regional 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.

RELATED TOPICS

   ABC’s of anesthesia

   What 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 the procedure.

   An 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.

   Your surgeon opens up the sheath covering your Achilles tendon.

   A 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.

   Surgeons typically gauge the tension of your Achilles tendon in your repaired side and make it equal to the other side.

   Incisions in your skin usually are closed with stitches and your ankle is put into a splint to immobilize it.

   You 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:

   Two weeks – Your physician removes the stitches and you receive a new cast that immobilizes your foot in a slightly bent-downward position.

   Four 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.

   Six 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.

RELATED TOPICS

   Recovery-proof your home

   When 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 an ankle stretching routine and performing foot and lower leg strengthening exercises.

Prevention

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.