The Achilles tendon is a strong fibrous cord behind the ankle that connects the calf muscles to the heel bone. It is the largest tendon in the body and used when you walk, run and jump. Rupture or tear of the achilles tendon generally occurs with sudden forceful push-off and is common during sports. It results in complete tearing and separation of the tendon fibres so the tendon can no longer perform its normal function.

Optimal treatment for this common injury has been extensively studied, yet it still remains somewhat controversial. What we do know is that with appropriate treatment the tendon will heal without or with surgery. The main benefit of surgery is a reduced risk of re-rupture and probably greater push-off strength. Most athletically active patients choose to have surgical repair.

Procedure

Achilles tendon repair first involves making a small incision through the back of the heel to expose the tear. Dr du Sart chooses to do this as minimally invasive surgery. Care is taken to avoid injury to surrounding structures. Surgical objectives include:

• Stitching the torn tendon back together with strong sutures,
• Reinforce the Achilles Tendon with other tendons depending on the extent of the tear
• Reattch the tendon to the heel bone (calcaneum) where it has avulsed or pulled off

After Your Operation

Pain Management

Post operation the foot is elevated to reduce swelling and local anaesthetic will provide pain relief and make the foot and toes temporarily numb. During your inpatient stay you will be given pain relief and either medication or prescriptions to go home to keep pain within comfort. Usually patients will initially require regular pain relief consisting of paracetamol and anti-inflammatories if indicated. Stronger medications may be given and helpful in early stages however are phased out as comfort levels increase.

Mobility

You are safe to mobilise with crutches as soon as you feel comfortable without fully weight bearing on the operated foot. The cast and sutures are removed at two weeks and you will be placed into a CAM boot with heel wedges/raises which is worn to week ten. You can continue to walk with the CAM boot and crutches. Once the incision has completely healed, a graduated rehabilitation program is commenced with progressive weight bearing, range of movement, and strengthening exercises. This is best done under the supervision of an experienced physiotherapist.

Return to Work and Sport

Return to work will vary on the nature of your work and what was done at surgery. In general, you should plan to have at least two weeks off work to allow your wound adequate time to heal and elevate your leg. You may be able to return to light duties after two weeks, but if you are on your feet at work, it may take 6 to 8 weeks. If you are very physically active in your job, it may take 3 to 6 months. Dr du Sart will discuss this with you at your post-op check.

Returning to sport such as jogging may take 4 to 6 months however this is dependent on the type and level of activity. Full recovery is expected in 6 to 12 months.

Driving

Times to return to driving will vary. If you have an automatic car and your left ankle was operated on, your return to driving may be faster. However, in general, plan to avoid driving for two weeks after surgery. However if your right ankle has been operated on it is recommended to return to driving after 12 weeks. If you have concerns, you can discuss this with Dr du Sart.