Achilles Tendon Rupture Surgery

Achilles Tendon Rupture Surgery Options

The Achilles tendon is a rope-like cord of tissue that connects the lower leg muscles to the heel. Achilles tendon repair is a surgery to repair an Achilles tendon that has been torn (ruptured). During the surgery the torn ends of the tendon are reconnected.

This procedure is typically done in an outpatient surgery center. It usually takes 30 to 60 minutes to complete. The surgery is usually successful, but the recovery period can be long.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have, including any skin conditions or infections you develop before surgery.
• Whether you are pregnant or may be pregnant.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reaction to medicines or dyes.
• Blood clots.
• Delayed healing.
• Scarring.
• Damage to other structures or organs, including damage to the nerve, causing numbness.
• Re-rupture of the tendon (rare).

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood.Do nottake these medicines before your procedure if your health care provider instructs you not to.
• You may be given antibiotic medicine to help prevent infection.

General instructions

• Your health care provider will examine the area from your lower leg to your heel.
• Your health care provider may order tests such as ultrasound or MRI, and may perform exams to check if:
  • You can point your toes up and down.
  • Your foot is in proper alignment.
• Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Shower or bathe on either the night before the surgery or the morning of the surgery.
• Plan to have someone take you home from the hospital or clinic.
• Ask your health care provider how your surgical site will be marked or identified.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
  • Hair may be removed from the surgical area.
  • A drape will be positioned around your lower leg.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine that is injected into an area of your body to numb everything below the injection site (regional anesthetic).
  • A medicine to make you fall asleep (general anesthetic).
• The surgeon will make an incision on the back side of your lower leg.
• The torn ends of your tendon will be stitched back together.
• The incisions will be closed with stitches (sutures) or staples.
• A bandage (dressing) will be applied over the incision.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You will feel some pain when the numbing medicine wears off. Your health care provider will prescribe pain medicine for you to take at home.
• Your leg may be put in a cast or splint.
• You will be given instructions to keep your leg above the level of your heart to reduce swelling and pain.
• You will not be allowed to put weight on your leg.
• You will need to use crutches or another type of walking aid to keep weight off your leg.
• You may continue to receive antibiotic medicine.

Summary

• The Achilles tendon is a rope-like cord of tissue that connects the lower leg muscles to the heel.
• Achilles tendon repair is a surgery to repair an Achilles tendon that has been ruptured.
• Follow your health care provider’s instructions before the procedure, including instructions on what to eat and drink and whether to stop taking your regular medicines.
• After your procedure, you will need to use crutches or another type of walking aid to keep weight off your leg.

Achilles Tendon Rupture Surgery, Care After

What can I expect after the procedure?

After the procedure, it is common to have:

• Numbness in your foot. This should go away within 24 hours.
• Pain.

It may take 6 months before you can return to your regular activity level. However, complete recovery can take a year or longer.

Follow these instructions at home:

If you have a splint:

• Wear the splint as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the splint if your toes tingle, become numb, or turn cold and blue.
• Keep the splint clean.
• If the splint is not waterproof:
  • Do notlet it get wet.
  • Cover it with a watertight covering when you take a bath or a shower.

If you have a cast:

• Do notput pressure on any part of the cast or splint until it is fully hardened. This may take several hours.
• Do notstick anything inside the cast to scratch your skin. Doing that increases your risk of infection.
• Check the skin around the cast every day. Tell your health care provider about any concerns.
• You may put lotion on dry skin around the edges of the cast. Do notput lotion on the skin underneath the cast.
• Keep the cast clean.
• If the cast is not waterproof:
  • Do notlet it get wet.
  • Cover it with a watertight covering when you take a bath or a shower.

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures) or staples in place. These skin closures may need to stay in place for 2 weeks or longer.
• Check your incision area every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Medicines

• Take pain medicines only as told by your health care provider.
• Do nottake over-the-counter medicines unless your health care provider says it is okay.
• To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
  • Drink enough fluid to keep your urine clear or pale yellow.
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.

Activity

• Do notwalk on or put weight on your injured leg.
• Use crutches or another walking aid.
• Follow your health care provider’s instructions on how to move your ankle and how much weight you can put on your leg. If you have a cast or splint, you should receive these instructions after it is removed.
• Follow your rehabilitation plan. Do exercises as told by your health care provider or physical therapist. Between 2–6 weeks after surgery, your surgeon may recommend:
  • Putting some weight on your leg while wearing your walking boot or cast.
  • Doing ankle motion exercises.
• Around 6 weeks after surgery, your surgeon may recommend:
  • Putting some weight on your leg without the assistance of a boot or cast.
  • Starting physical therapy to improve ankle motion and to strengthen muscles in your leg.
• Avoid stretching your Achilles tendon for at least 6 months or as told by your physical therapist.
• Do not return to physical activity or sports until you are cleared by your health care provider or physical therapist.

Driving

• Do notdrive or operate heavy machinery while taking prescription pain medicine.
• If you have a cast, splint, or boot on your leg, ask your health care provider when it is safe for you to drive.

General instructions

• Raise (elevate) your leg above the level of your heart while you are sitting or lying down.
• Do not take baths, swim or use a hot tub until your health care provider approves.
• If directed, put ice on the injured area:
  • If you have a removable splint, remove it as told by your health care provider.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• See a physical therapist if directed by your health care provider. A physical therapist can help you regain ankle motion and strengthen your leg muscles.
• Keep all follow-up visits as told by your health care provider. This is important. If you have a cast or splint, you should see your health care provider about 2 weeks after surgery to have it removed. If you have stitches, your health care provider will also take them out during this time.

Contact a health care provider if:

• You have chills.
• You have a fever.
• Your pain medicine is not working.
• You have persistent numbness or burning.
• You have redness, swelling, or pain around your incision.
• You have fluid or blood coming from your incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision.
• You feel like your cast or splint is too tight.
• You are unable to wiggle your toes.
• You have a cast or splint and have increased pain.
• You have numbness or tingling in your foot or toes.
• You notice cracks or soft spots on your cast.

Get help right away if:

• You have swelling, pain, or numbness that is getting worse.
• You are bleeding through your cast or splint.
• You have chest pain.
• You have trouble breathing.

Summary

• After your procedure, it is common to have pain and numbness in your foot. Numbness should go away within 24 hours after surgery.
• If you have a splint, loosen it if your toes tingle, become numb, or turn cold and blue. Keep the splint clean and dry.
• If you have a cast, do not put pressure on it until it hardens. To avoid infections, do not stick objects under the cast to scratch the skin and do not put lotion under the cast. Keep the cast clean and dry.
• Follow your health care provider’s instructions about caring for your incision, avoiding some activities, taking medicines, and keeping follow-up visits.

Achilles Tendon Rupture With Nonsurgical Treatment

The Achilles tendon is a rope-like cord of tissue that connects the lower leg muscles to the heel. You use this tendon when you push your foot down to walk or run. An Achilles tendon rupture is a tear in this tendon. The injury prevents you from being able to do your regular physical activities.

What are the causes?

This condition can be caused by sudden stress applied to the tendon, such as from:

• A hit to the tendon.
• A forceful and unexpected movement of your toes in an upward direction.
• Quickly pushing off the ground with your toes, such as at the start of a race.

This condition can also be caused by weakening (degeneration) of the tendon.

What increases the risk?

You are more likely to develop this condition if:

• Your Achilles tendon has been injured more than once.
• You have had Achilles tendinitis.
• You have a disease that affects the blood vessels of the tendon (vascular disease).
• You have stress on the tendon that happens regularly.

What are the signs or symptoms?

• Feeling as if you were struck violently in the back of the ankle.
• Hearing a pop or crack at the time of injury.
• Experiencing severe, sudden pain at the time of injury. Some people with this condition do not feel pain.

How is this diagnosed?

This condition is usually diagnosed with a physical exam. During the exam, your health care provider will touch the tendon and the structures around it. You may be asked to lie on your stomach or kneel on a chair for part of the exam. You most likely have a ruptured tendon if your foot does not flex.

Sometimes imaging tests are done. Tests may include:

• An ultrasound.
• An MRI.

How is this treated?

This condition may be treated with surgery or by keeping the area still (immobilized) with a cast, boot, or splint and with rehabilitation. Additional treatment for this condition may involve:

• Applying ice to the area.
• Taking medicines for pain.
• Using crutches and keeping weight off the leg.
• Physical therapy to regain strength and range of motion in the ankle.

Follow these instructions at home:

If you have a splint or boot:

• Wear it as told by your health care provider. Remove it only as told by your health care provider.
• Loosen it if your toes tingle, become numb, or turn cold and blue.
• Keep it clean.
• If it is not waterproof:
  • Do notlet it get wet.
  • Cover it with a watertight covering when you take a bath or a shower.

If you have a cast:

• Do notput pressure on any part of the cast or splint until it is fully hardened. This may take several hours.
• Do notstick anything inside the cast to scratch your skin. Doing that increases your risk of infection.
• Check the skin around the cast every day. Tell your health care provider about any concerns.
• You may put lotion on dry skin around the edges of the cast. Do notput lotion on the skin underneath the cast.
• Keep the cast clean.
• If the cast is not waterproof:
  • Do notlet it get wet.
  • Cover it with a watertight covering when you take a bath or a shower.

Managing pain, stiffness, and swelling

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Raise (elevate) the injured area above the level of your heart while you are sitting or lying down.
• Do notdangle your leg over a chair, couch, or bed.
• If directed, put ice on the injured area:
  • If you have a removable splint, remove it as told by your health care provider.
  • Put ice in a plastic bag.
  • Place a towel between your skin and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.

Activity

• Move about only as instructed by your health care provider.
• Avoid using the injured area except to move your toes from time to time.
• Do notdrive a car until your health care provider tells you it is safe to do so.
• Do not return to physical activity or sports until cleared by your health care provider or physical therapist.

General instructions

• Do notuse the injured limb to support your body weight until your health care provider says that you can. Use crutches as told by your health care provider.
• Follow your rehabilitation plan. Do exercises as told by your health care provider or physical therapist.
• Avoid stretching your Achilles tendon for at least 6 months or as told by your physical therapist.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• Your pain and swelling get worse.
• Your pain is not controlled by medicines.
• You have new, unexplained symptoms.
• Your symptoms get worse.
• You cannot move your toes or foot.
• You develop warmth and swelling in your foot.
• You have an unexplained fever.

Summary

• An Achilles tendon rupture is a tear in the rope-like cord of tissue that connects the lower leg muscles to the heel.
• This may be treated by keeping the ankle immobilized, keeping weight off the leg, and taking medicines. Physical therapy and icing can also be used.
• Wear your cast, splint, or boot as told by your health care provider. Keep it clean and do not get it wet.

Achilles Tendon Repair Rehabilitation

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse.  Do notbegin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your lower leg and heel. These exercises also help to relieve pain, numbness, and tingling.

Exercise A: Dorsiflexion and plantar flexion, active range of motion

1. Sit with your left / right knee straight or bent. Do notrest your foot on anything.
2. Flex your left / right ankle to tilt the top of your foot toward your shin. Stop at the first point of resistance or at the angle where your health care provider told you to stop.
3. Hold this position for __________ seconds.
4. Point your toes downward to tilt the top of your foot away from your shin.
5. Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise B: Ankle alphabet

1. Sit with your left / right leg supported at the lower leg.
   • Do notrest your foot on anything.
   • Make sure your foot has room to move freely.
2. Think of your left / right foot as a paintbrush, and move your foot to trace each letter of the alphabet in the air. Keep your hip and knee still while you trace.
3. Trace every letter from A to Z.

Repeat __________ times. Complete this exercise __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your lower leg. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise C: Dorsiflexion

1. Secure a rubber exercise band or tube to an object, such as a table leg, that will stay still when the band is pulled. Secure the other end around your left / right foot.
2. Sit on the floor facing the object with your left / right leg extended and your toes pointing down. The band or tube should be slightly tense when your foot is relaxed.
3. Slowly flex your left / right ankle and toes to bring your foot toward you. Stop when you feel resistance in your Achilles tendon or stop at the angle where your health care provider told you to stop.
4. Hold this position for __________ seconds.
5. Slowly return your foot to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Eversion

1. Sit on the floor with your legs straight out in front of you.
2. Loop a rubber exercise band around your left / right foot, across the top part of the walking surface (ball) of that foot. Hold the band in your hands or secure it to a stable object.
3. Slowly push your foot outward, away from your other leg.
4. Hold this position for __________ seconds.
5. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Inversion

1. Sit on the floor with your legs straight out in front of you.
2. Loop a rubber exercise band around your left / right foot, across the top part of the walking surface (ball) of that foot. Hold the band in your hands or secure it to a stable object.
3. Slowly push your foot inward, toward your other leg.
4. Hold this position for __________ seconds.
5. Slowly return your foot to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise F: Plantar flexion, seated

1. Sit on a chair with your feet flat on the floor.
2. If told by your health care provider, place __________ lb. on your left / right knee.
3. Keeping your toes firmly on the floor, lift your left / right heel as far as you can without increasing any discomfort in your ankle.
4. Bring your heel back down to the floor.

Repeat __________ times. Complete this exercise __________ times a day.

Advanced exercises

 Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do notbegin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your lower leg and heel. These exercises also help to relieve pain and stiffness.

Exercise A: Gastroc and soleus stretch

1. Sit on the floor with your left / right leg extended.
2. Loop a belt or towel around your left / right foot, across the top part of the walking surface (ball) of your foot.
3. Keep your left / right ankle and foot relaxed and keep your knee straight while you use the belt or towel to pull your foot and ankle toward you. You should feel a gentle stretch behind your calf or knee.
4. Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your lower leg. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise B: Plantar flexion with band

1. Sit on the floor with your left / right leg extended.
2. Loop a rubber exercise band or tube around your left / right foot, across the top part of the walking surface (ball) of your foot. Hold the two ends in your hands. The band or tube should be slightly tense when your foot is relaxed.
3. Slowly point your toes downward, pushing them away from you.
4. Hold this position for __________ seconds.
5. Slowly return your foot back to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise C: Plantar flexion, standing

1. Stand with your feet shoulder-width apart. Start this exercise standing on a flat floor. When told by your health care provider, you can do this exercise with the balls of your feet on a step.
2. Keep your weight spread evenly over the width of your feet while you rise up on your toes. Use a wall or table to steady yourself, but try not to use it for support.
3. If this exercise is too easy, try these options:
   • Shift your weight toward your left / right leg until you feel challenged.
   • If told by your health care provider, stand on your left / right leg only.
4. Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times a day.

Balance exercises

These exercises improve or maintain your balance. Balance is important in preventing falls.

Exercise D: Inversion/eversion

You will need a balance board for this exercise. Ask your health care provider where you can get a balance board or how you can make one.

1. Stand on a non-carpeted surface near a countertop or wall.
2. Step onto the balance board so that your feet are hip-width apart.
3. Keep your feet in place and keep your upper body and hips steady. Using only your feet and ankles to move the board, do one or both of the following exercises as told by your health care provider:
   • Tip the board side to side as far as you can, alternating between tipping to the left and tipping to the right. If you can tip the board so it touches the floor, let the board silently tap the floor. Do notlet the board forcefully hit the floor. From time to time, pause to hold a steady position.
   • Tip the board side to side so the board does nothit the floor at all. From time to time, pause to hold a steady position.

Repeat the movement for each exercise __________ times. Complete each exercise __________ times a day.

Exercise E: Plantar flexion/dorsiflexion

You will need a balance board for this exercise. Ask your health care provider where you can get a balance board or how you can make one.

1. Stand on a non-carpeted surface near a countertop or wall.
2. Step onto the balance board so that your feet are hip-width apart.
3. Keep your feet in place and keep your upper body and hips steady. Using only your feet and ankles to move the board, do one or both of the following exercises as told by your health care provider:
   • Tip the board forward and backward so the board silently taps the floor. Do notlet the board forcefully hit the floor. From time to time, pause to hold a steady position.
   • Tip the board forward and backward so the board does nothit the floor at all. From time to time, pause to hold a steady position.

Repeat the movement for each exercise __________ times. Complete each exercise __________ times a day.

Exercise F: Tandem walking

Do this exercise in a hallway that is at least 10 ft. (3 m) long.

1. Stand with one foot directly in front of the other. You can use the walls to help you balance if needed, but try not to use them for support.
2. Slowly lift your back foot and place it directly in front of your other foot.
3. Continue to walk in this heel-to-toe way for __________ ft. or for as long as told by your health care provider.

Repeat __________ times. Complete this exercise __________ times a day.