Achilles tendon surgery

Tendo Achilles debridement, Tendo Achilles debridement and FHL transfer
Summary

This operation is performed for symptoms caused by a degenerate Achilles tendon. The aim of the operation is to remove the degenerate tendon to promote a healing response and the regeneration of normal tendon tissue.  

Factors to Consider

Symptoms from Achilles tendinopathy vary significantly between patients. Some patients may have discomfort to the heel only after strenuous exercise whereas others will have severe pain that prevents them from walking comfortably or doing their normal activities. The severity and duration of your symptoms will dictate whether you should proceed to surgery.

It is likely that you have already tried non-surgical treatments for your Achilles tendinopathy such as pain killers, injections, physiotherapy, shockwave therapy and orthotics.  If these measures have not improved your symptoms then the next logical step is to consider surgery.

Description of Surgery

The operation can usually be performed as a daycase procedure but you will need to ensure that there is someone to drop you off and pick you up from the hospital.  You will also need to have a responsible adult at home with you on the night of the operation.

The operation may be performed open through a short incision at the back of your heel or in some cases it is keyhole surgery may be possible.  The surgeon will then identify the Achilles tendon and cut out the portion of the tendon that is diseased.  The surgeon may take the Achilles tendon from its attachment on the heel and reattach it.  In severe cases it is sometimes necessary to use one of the other foot tendons to replace part of the Achilles tendon.

The operation takes about 60 minutes.

Anaesthetic

The operation is usually performed under a general anaesthetic and so you will be given instructions as to when you need to stop eating and drinking (normally the night before) before you come into hospital.  

Your pain can be well controlled with local anaesthetic given during the operation.

What are the risks?

All operations involve an element of risk.  The risks for this particular operation are small but it is important that you are aware of them.

The main risk for this operation is wound problems in the first 3 weeks after surgery due to the fact that wounds around this area are slow to heal.  This means that infections can also occur, although, not commonly.  This usually settles with antibiotics but may require further surgery

Damage to nerves and blood vessels around the foot can occur but this is rare.  Any surgery to the Achilles increases the risk of developing a clot in your leg (DVT).  Your surgeon will assess your risk of this prior to surgery and may offer you blood thinning medication if your risk is considered high.

After Surgery

Pain

Local anaesthetic will be used during the operation and so you will feel comfortable when you first wake up.  This can last up to 12 hours but the foot may be sore after it wears off.  You will be given a combination of pain killers to go home with.  

Dressings

You will wake up with your foot in a plaster.  This is kept on for the first 2 weeks to allow the wounds to heal.  You will not be allowed to weight bear during the first 2 weeks.  The surgeon will give you instructions as to when you can start weight bearing as this will depend on how damaged the Achilles tendon is at the time of surgery.

Physiotherapy

The physiotherapist should see you before the operation to explain some simple exercises you can do after the operation.  They will also ensure a physiotherapy appointment is made for you within 3 weeks of the operation.  Physiotherapy can be arranged local to you.  

Driving

You can drive when you feel you are safe to drive.  This means that you feel confident that you have full control of your car and are able perform an emergency stop.  This will vary between patients (which leg is operated on, manual vs automatic car) and the surgery performed but may take from  4-12 weeks.  

Return to work

This depends on what your job is.  You should be able to return to a “desk job” within a few weeks of your surgery.  If you have a more manual job it can take up to 12 weeks before you feel ready to return to work.  Please discuss this further with your surgeon or physiotherapist if you feel unsure.  A sick note can be given to you at the time of your surgery if required.  Please ask the nurses on the ward if you need one.

What to expect

Recovery following surgery can be quite variable but the expectation is that “it takes 3 months to be fair, 6 months to be good and 12 months to be right”.