Do I need Achilles Surgery?
In the case of Achilles tendon rupture, nonoperative treatment is a viable option. If the rupture is caught early, the patient can be placed in a plantar flexed splint or cast to allow the tendon edges to heal together. It is important to point the toes downward to close the gap created during the rupture. Cast and use of a CAM boot usually lasts weeks to months and varies from patient to patient. Nonoperative treatment is a very safe and cost effective way to treat an Achilles tendon rupture and often used in patients who are at high risk for surgical complications. The scientific literature is mixed as to whether long term strength is as good with nonoperative treatment when compared to operative treatment.
Achilles Tendon Surgery
Achilles tendon surgery can be done with a classic open approach or a minimally invasive, percutaneous approach. Both options yield old good clinical outcomes for the patient. The scientific literature shows that large, open incisions have a higher risk of wound complications.
How to Perform an Achilles Tendon Repair
Achilles tendon surgery is done in an outpatient setting. It involves a general anesthetic and an incision over the Achilles tendon. There are multiple techniques used to repair the tendon and the preferred treatment continues to evolve. After an Achilles repair the patient is placed in a postoperative splint, to allow for swelling, and discharged home.
Surgical intervention usually involves the use of a regional nerve block or catheter. This controls pain for the first 12-48 hours depending on the type of block used. As the nerve block wears off, the patient is provided with oral pain medication. The pain usually lasts 2-3 days then subsides significantly.
Achilles Tendon Rehabilitation
Following operative intervention, the patient is nonweightbearing for the first few days after the surgery. The patient is then placed in a removable CAM boot with heel lifts. The patient is allowed to begin weightbearing in the removable boot and starts physical therapy. The boot is removed between 4 and 8 weeks, depending on the patient. Further recovery takes 3-6 months. Return to full, competitive, explosive activities typically takes 6 months to 1 year.