Achilles Tendon Repair

Type of Procedure: Outpatient

Length of Procedure: 1-1.5 hrs

Anesthesia: Regional nerve block with general anesthesia or sedation

Medications: Oxycodone or Norco for pain, aspirin 81 mg twice daily for 3 weeks to lower risk of blood clots, ondansetron for nausea

Follow-up appointments: 2 weeks, 6 weeks, 12 weeks

Time Non Weight Bearing: 2 weeks no weight, progress weight bearing per protocol until full bearing in boot at 6 weeks

Time to Driving: When off narcotics for left ankle unless you have a clutch, 8-9 weeks for right ankle

Achilles tendon rupture: General facts

• Usually from contracting ankle suddenly upwards while foot is pointed downwards or from a direct blow
• Commonly an athletic injury seen in jumping sports
• Diagnosis is usually made based on examination
  • Occasionally MRI scan or ultrasound are needed

Achilles Tendon Anatomy

• The Achilles tendon is the large tendon in the back of the ankle
• It attaches to the heel bone (calcaneus)
• It is responsible for pointing the ankle downwards and pushing off the ground
• It has an area of poor blood supply that often is the site of rupture

Treatment of Achilles tendon ruptures

• If the tendon is separated significantly and a patient is active, operative repair is typically recommended
• Surgery involves an incision over the back of the ankle
• Sutures are then inserted into the stumps of the Achilles tendon either through a minimally invasive or open technique
• The ankle is then placed into the proper position and the ends of the tendon are tied together
• Occasionally, we have to anchor the sutures from the Achilles tendon into the heel bone through two small incisions if your rupture is very close to the heel bone
• Occasionally, we have to take the tendon that flexes your big toe downwards and anchor it to the heel bone to strengthen the Achilles tendon repair
• The goal of the surgery is to restore the tension on the Achilles tendon and allow for return to desired activity level

Before Surgery:

1. Elevate extremity
2. Ice the affected Achilles
3. You may walk on the affected leg in a boot with white wedges

After Surgery:

1. Immediately after:
   1. In splint below the knee (do not get splint wet); the splint will have your ankle pointed down to protect the repair
   2. Elevate the leg, Ice, take pain medication
   3. No weight (use crutches, walker, knee scooter, or wheelchair)
2. 2 week appointment:
   1. Stitches come out and steri-strips placed
   2. Placed into boot with wedges under your heel
   3. Begin toe touch weight bearing in the boot and advance weight bearing with assistance of therapist per Dr. Dean’s protocol
   4. Begin physical therapy
   5. May run soapy water down incisions but do not scrub or soak
3. 6 week appointment:
   1. Begin weaning into shoe with wedges with help of therapist
   2. Begin stationary bike in seated position
   3. Begin stretching of Achilles at 10 weeks postop
4. 12 week appointment:
   1. Begin strengthening
   2. Begin to run and jump 4 mos after surgery
   3. Can return to sport at 4.5-5 mos