Why would I need an Achilles reconstruction?

The most common reason for requiring a reconstruction operation of the Achilles tendon is when a rupture has occurred more than a few weeks previously. Within the first few weeks after rupture a direct repair of the tendon or even non-operative treatment is possible. After this time, direct repair is not possible, and so some form of reconstruction is needed. The other use for the operation is in severe cases of Achilles tendonitis, which have not responded to other treatments.

What other treatments are available?

Sometimes it is appropriate to manage without surgery after chronic Achilles rupture. In this case, a splint called an ankle foot orthosis (AFO) can be made to fit in the shoe, which adds strength to the ankle. Alternatively, a high-top boot can be worn, or special modifications made to the shoes. However, in many cases the resulting weakness after Achilles rupture is unacceptable.

What does the operation involve?

The operation is carried out under general anaesthesia, often supplemented with a local anaesthetic block for pain relief. Many different operations have been described to reconstruct the Achilles tendon, but Mr Dega and Mr Clark both favour a tendon transfer operation. An incision is made over the Achilles, and sometimes another inside the arch of the foot. The tendon to the big toe is borrowed and weaved through the Achilles tendon remnants, making a very strong repair.

What about pain?

Whilst you are in hospital you will be monitored and the medical staff will give you painkillers as required and prescribed. You will be given painkillers and instructions on management of the pain by the nursing staff before you leave hospital.

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How long does recovery take?

Most patients remain in hospital for 2 – 3 days after the operation. You will have a temporary cast below the knee, and will usually be required to non-weight bear with crutches initially. Occasionally you will be allowed to bear weight after a few days.

Your temporary cast and wound dressings will be changed and stitches removed (if applicable) at the clinic during your follow-up appointment, which is usually about 10 days after the operation. In those patients allowed to bear weight sooner, a walker boot is applied after only a few days.

Swelling is quite common after foot and ankle surgery and this is best managed by elevating the foot at regular intervals. You are advised to elevate the operated foot/ankle on a pillow every night and during the day on three separate occasions, e.g. 11am, 3pm and 6pm for about one hour each time. The above measures will help to reduce swelling of the ankle. These instructions should be followed for at least 10-14 days.

After 10 days you will be allowed “protected weight-bearing” in a special removable walker-boot. The usual length of time until unprotected weight-bearing is 10 weeks.

Patients having had the left ankle operated on will be able to drive an automatic car within 2-3 weeks (short distances only to avoid swelling). Those who have had an operation on the right side will be able to drive after about 12 weeks. You are advised not to fly after surgery for about six weeks.

If you have a desk job and are able to get to work, you should be able to return to work with your foot up in the boot or plaster after 2-4 weeks. If on the other hand you do manual work, you will need at least 12 weeks off work.

After Achilles tendon reconstruction the ankle can be stiff and almost always requires a period of physiotherapy, which also helps to recover strength in the calf muscle. Golf, walking and even running short distances are all possible after a successful reconstruction.

Post Op Physio ProtocolVacoped Protocol

What can go wrong?

All operations have an in-built risk and complication rate. The risks for Achilles tendon reconstruction are as follows:

  • Infection
  • Prolonged swelling
  • Nerve or blood vessel injury
  • Stiffness of the ankle
  • Deep vein thrombosis (clot in vein)
  • Pulmonary embolus (clot in lung)
  • Post-operative pain (including complex regional pain syndrome)
  • Re-rupture
  • The above complications are rare but can occur.