Thursday, April 11, 2024

3 Years After Achilles Tendon Surgery

Conservative Vs Surgical Intervention

Achilles Tendon Recovery #7-3 years

There is much debate in the literature about treatment for achilles tendon rupture with the two options comprising of a conservative or surgical approach. Many studies have shown that the re-rupture rates are higher in cases of non-operative management. More recently studies have demonstrated equivalent or improved rates of re-rupture compare with surgical intervention. However, many people continue to be treated with surgical repair and physiotherapists will continue to see them for post-operative rehabilitation in their clinics.

What Are The Risks Of Surgery

The risks of surgery are similar, whether you have percutaneous surgery or open surgery. The biggest risk of either type of surgery is wound infection. It is more common with open surgery. Your risk can also change depending on whether you begin walking and using your foot sooner after surgery rather than later. This is called early mobilization.

The small risk of other complications was about the same with either open or percutaneous surgery, and most problems go away over time. These complications included pain, delayed wound healing, nerve damage, and problems with scarring.

What Happens After Achilles Tendon Repair Surgery

A healthcare provider will watch you for a few hours after your surgery. When you wake up, you will likely have your ankle in a splint. This is to keep it from moving. Achilles tendon surgery is often an outpatient procedure. This means you can go home the same day.

You will have some pain after your surgery, especially in the first few days. Pain medicines will help relieve your pain. Keep your leg elevated as often as possible. This can help reduce swelling and pain. Make sure to tell your healthcare provider right away if you have a high fever or pain in your ankle or calf that gets worse. After your surgery, you will likely need to use crutches. This is so you can keep your weight off your leg.

About 10 days after your surgery, youll need to return to your healthcare provider to have your stitches removed. Your healthcare provider might replace your splint with a cast at this time. If so, follow all instructions about keeping your cast dry. Or, your healthcare provider may give you a special removable boot instead of a cast.

Your healthcare provider will give you instructions about when you can put weight on your leg. He or she will tell you how to strengthen your ankle and leg muscles as you recover. You may need to do physical therapy to help with your recovery.

Make sure to follow all your healthcare providers instructions about medicines, wound care, and exercises. This will help make sure the surgery is a success for you.

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What Matters Most To You

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to choose surgery for a ruptured Achilles tendon

Reasons to choose a cast or brace to treat a ruptured Achilles tendon

I don’t want to risk having another tendon rupture.

I’m willing to take the risk of having another tendon rupture if it means not having surgery.

What To Expect At Your First Post

Achilles Treatment Patient Stories

10-12 days following the surgery

At your first post-op appointment, the splint will be removed. The wound is checked for proper healing, and the sutures are removed at this time. You will then be fitted with a removable walking cast along with two heel lifts. The heel lifts allow for continued healing of the Achilles tendon and prevent the tendon from being overstretched. You may also remove the CAM walker a couple of times a day to perform gentle range of motion exercises with your ankle . You may remove one heel lift after wearing the CAM walker for a week, and you may remove the 2nd heel lift after you can bend your ankle upwards to a 90 degree angle. This usually occurs after the 2nd week. You may start placing weight on your foot once the 2nd heel lift has been removed. Consider partial weight-bearing , increasing to full weight-bearing over the course of a few days.

It is recommended that you wear the CAM walker at all times, including nighttime, for the first two weeks. However, it may be removed to shower. After two weeks of wearing the CAM walker, you may discontinue wearing it at night. You must continue to wear it during the day and whenever weight-bearing.

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What Else Do You Need To Make Your Decision

Check the facts

  • You’re right. You are less likely to have another rupture after surgery than after treatment with a cast or brace.
  • Sorry, that’s not right. You are less likely to have another rupture after surgery than after treatment with a cast or brace.
  • It might help to go back and read “Get the Facts.” You are less likely to have another rupture after surgery than after treatment with a cast or brace.
  • You are right. Like most surgeries, Achilles tendon surgery does have some risks that nonsurgical treatment does not have, such as a deep wound infection.
  • Sorry, that’s not right. Like most surgeries, Achilles tendon surgery does have some risks that nonsurgical treatment does not have, such as deep wound infection.
  • It may help to go back and read “Get the Facts.” Like most surgeries, Achilles tendon surgery does have some risks that nonsurgical treatment does not have, such as deep wound infection.
  • Sorry, that’s not right. People who have surgery are less likely to have problems with walking than people who use immobilization.
  • You are right. People who have surgery are less likely to have problems with walking than people who use immobilization.
  • It may help to go back and read “Get the Facts.” People who have surgery are less likely to have problems with walking than people who use immobilization.

Out of 100 people who have the surgery, 2 to 3 of them will get a deep infection. This means that 97 to 98 will not.

Understanding the evidence

What Is Achilles Tendon Repair Surgery

Achilles tendon repair surgery is a type of surgery to fix a damaged Achilles tendon.

The Achilles tendon is a strong, fibrous cord in the lower leg. It connects the muscles of your calf to your heel. Its the largest tendon in your body. It helps you walk, run, and jump.

In some cases, the Achilles tendon can tear, or rupture. This is usually due to a sudden, strong force. It can happen during tough physical activity. It can happen if you suddenly move faster or pivot on your foot. Having a foot that turns outward too much can increase your risk of a torn tendon. A ruptured Achilles tendon can cause pain and swelling near your heel. You may not be able to bend your foot downward.

The Achilles tendon can also degenerate. This is also known as tendinitis or tendinopathy. This might cause symptoms like pain and stiffness along your Achilles tendon and on the back of your heel. This is most often through overuse and repeated stress to the tendon. It can result from repeated stress on your tendon, especially if you have recently been more active. Having short calf muscles can increase your risk of tendinopathy.

In some cases, the Achilles tendon repair surgery can be done as a minimally invasive procedure. This is done with several small incisions instead of one large one. It may use a special scope with a tiny camera and a light to help do the repair.

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Conditioning Before And After Surgery

Pre-op conditioning: Prepare for the surgery through low impact cardiovascular exercises such as biking, swimming, elliptical machine, stair master, rowing machine.

Strength training should continue with a heavy emphasis on eccentric loading of the calf musculature. The strength program should include the core and entire lower extremity musculature. Avoid sharp pain in Achilles tendon when you perform the exercises.

Post-op week 1: The doctor or Physical Therapist will guide you through the rehabilitation process and your doctors protocols will determine level of weight bearing. During this time, you should begin to strengthen your core and lower extremities. Your Physical Therapist can give you a work- out routine that will protect the surgically repaired Achilles tendon and challenge the other muscle groups. For example, you can ride a stationary bike as a form of cardiovascular exercise. You dont want to push on the pedal with the ball of your foot of the surgically repaired Achilles tendon. If you move your foot forward on the pedal and keep the boot on you can pedal with the arch or heel of the involved foot.

Achilles Tendon Resting Angle

Do Achilles Tendon Tears Require Surgery?

The Achilles tendon resting angle has previously been reported to have excellent testretest reliability . With the patient in a prone position and the knee passively flexed at 90 degrees, a goniometer with one-degree increments was placed with one arm along the shaft of the fibula aligned with the center of the fibula head and the other arm with the head of the fifth metatarsal. The angle between the arms was used for analysis.

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What Is Achilles Tendinosis Surgery

Achilles Tendinosis Surgery removes the chronically damaged tendon fibers that have not healed and have been diagnosed as Tendinosis. In the best case scenario, the damaged fibers do not constitute the entire tendon and only a portion of the fibers are removed. If the entire tendon is damaged, the surgeon will have to cut the tendon horizontally to remove the damaged area and then surgically reattach it. If this occurs, the surgery and rehabilitation are similar to that of a ruptured Achilles tendon.

For now, lets consider what surgery and rehabilitation looks like when the total repair of the tendon is not required. The surgical procedure consists of a longitudinal incision . The type of incision is critical in the rehabilitation process, impacting your ability to weight bear and strength train. Because the longitudinal incision is along the natural orientation and pull of the fibers, it allows for more aggressive rehabilitation.

Think of a piece of garden hose with strands of leather like longitudinal bands inside it: some of those strands are damaged and will not heal. The surgeon cuts the outer shell of the hose longitudinally and can locate the damaged bands. The bands are surgically cut out and removed similar to a cookie cut-out. The surgeon then sutures the outer shell together along the longitudinal incision.

What Is Already Known

  • Achilles tendon rupture is a common injury in high-level athletes, especially those in sports requiring explosive movements.

  • Achilles tendon rupture is a debilitating injury for high-level athletes causing an extended time loss from sport.

  • Professional athletes generally opt for surgical intervention, although high-level evidence demonstrates good outcomes from non-operative management in the general population with early functional rehabilitation.

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How Can You Prevent Achilles Tendon Injuries

They may be strong and durable, but its still important to take care of your Achilles tendons. The best thing you can do for them is to ease into activities and gradually train them to do what you want them to do.

You can reduce your risk of Achilles injuries by:

  • Warming up and cooling down every time you exercise or play sports
  • Slowly increasing the length and intensity of workouts
  • Avoiding or limiting exercise on uneven surfaces
  • Wearing well-fitting shoes

If you tear your Achilles tendon, you can expect a long recovery. But our team of foot and ankle specialists, orthopaedic surgeons, and physical therapists will work with you to get on your feet and back in the game as soon as possible.

To talk to one of our experts about an Achilles tendon injury, call or schedule an appointment online.

The Importance Of Rehabilitation Following Diagnosis And Treatment

References in Bilateral Cadaveric Achilles Tendon Graft in ...

In addition to the need for early diagnosis and treatment, patients should be aware of the requirement that appropriate measures for rehabilitation are implemented as soon as possible after removal of the plaster cast which is used for both non-surgical and surgical modes of treatment.

Typically, patients will be referred for physiotherapy where they will undergo gentle strengthening and balancing exercises to aid their recovery. With early/prompt diagnosis and treatment and appropriate rehabilitation, a very good recovery is to be expected. A 95% return in the function of the tendon, in comparison with its pre-injury function, can be anticipated. Unfortunately, in cases involving delayed presentations and treatment for Achilles tendon injuries, the outcome in terms of the return of the function is likely to be significantly less. This can result in residual symptoms of discomfort which can often be exacerbated in different weather conditions, and problems with balance, altered gait, poor strength of the affected leg resulting in over-compensating with the uninjured leg, and issues with mobility.

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What Happens In Achilles Tendon Repair Surgery

Surgical repair is usually an outpatient procedure followed by several weeks of protection in a cast or boot. Physical therapy and exercises may begin as soon as the surgical incision is healed.

You will be placed under anesthesia to sleep through the surgery. The surgeon will open the skin of the calf and back of the ankle. In some cases, minimally invasive or percutaneous repair through small incisions can be used. In other cases, an incision of about three to four inches may be necessary.

During the procedure, the surgeon will open the sheath of tissue around the tendon and remove damaged tissue. Then, they will repair the tear. If the tear is significant, the surgeon might remove a small piece of tendon from elsewhere in your foot and use it to replace a portion of the Achilles tendon. Then, the surgeon will close the incision with sutures. Most patients can return home the same day.

With surgical or nonsurgical treatment, you likely will be walking normally in about three months. Physical therapy will focus on regaining strength in the leg and tendon, as well as increasing flexibility so you can safely perform more explosive athletic maneuvers such as running, jumping, or pivoting.

How Well Do Treatments Work

Surgery is the most common treatment for Achilles tendon rupture. It reattaches the torn ends of the tendon. It can be done with one large incision or many smaller incisions .

Nonsurgical treatment starts with immobilizing your leg. This prevents you from moving the lower leg and ankle so that the ends of the Achilles tendon can reattach and heal. A cast, splint, brace, walking boot, or other device may be used to do this.

Both immobilization and surgery are often successful. They both help the tendon to heal. Another rupture is less likely after surgery than after immobilization, but immobilization has fewer other risks.

The success of your surgery depends on:

  • Your surgeon’s experience.
  • The type of surgery you have .
  • How badly your tendon is damaged.
  • How soon after the rupture your surgery is done.
  • How soon your rehabilitation program starts after surgery.
  • How well you follow your rehab program.

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Why Does Recovery Take So Long

Unlike muscle tissue, tendons dont get a significant supply of blood. Blood delivers fluid and nutrients that are essential for healing.

The less blood delivered, the longer it takes for tissue to heal. Add to that the sheer size of the Achilles tendon, and youre in for a lengthy recovery. Even for professional athletes these are usually season-ending injuries, and in some cases career-ending injuries.

With a tear or rupture, you’ll likely be out of commission for at least one season of your sport of choice. Even walking will be difficult, if it’s possible at all, for several weeks during initial recovery.

Your treatment plan will depend on many factors, including the severity of the injury. The non-surgical approach involves keeping the foot and ankle flexed downward with a boot or cast, followed by physical therapy. The goal would be for the tear to heal itself. However, many cases require surgery for proper healing.

Still In Pain After Achilles Surgery

Intermediate Achilles Tendon Rupture Repair Rehab

I had Achilles reconstruction surgery back on December 20, 2016. I’m still in pain almost 5 months later.

I’ll give a little history. I started having heel pain in January 2016. Doctor told me I had tendonitis. I started with physical therapy and it unfortunately did not help. I wore a boot for 6 weeks and that didn’t help either. Dr. referred me to another Dr. who does tenex procedure. I had that on August 8. While I was in therapy I ended up tearing my tendon. The Dr. referred me to a surgeon and that’s when I decided on the surgery.

0 likes, 99 replies

  • Posted 5 years ago

    I’m 9 months post ATR Zan’s I have pain every day! Still can’t bear ANY weight on my toes and can only wear athletic shoes. It’s a very slow process

  • 5 years ago

    Hi Donna

    Sorry to hear you’re still in pain. I tried putting inserts for heel and arch support. It felt good at first but I think they are already worn out. I’m going to look into some new sneakers as well.

    Do you still get the shooting pains in the tendon or is it pain from swelling? Or both? I have pain from both. I still walk with a limp. I don’t have full range of motion in my foot yet. It’s going to take a bit of time I suppose. Good luck to you. Keep me updated on your recovery

  • Posted 4 years ago

    Hi cilia! Sorry I haven’t checked this thread in several months. How are you making out? Did you get the second opinion? I hope you’re feeling better.

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