SURGICAL TREATMENT

Surgery for Achilles tendon ruptures can be categorized as traditional open procedures and mini-open procedures. The open traditional open repair re-approximates the ruptured tendon with direct visualization of the wound bed. The benefits of direct visualization limit the potential for iatrogenic sural nerve injury at the expense of increased wound complications. Mini-open procedures, also referred to as percutaneous repair, utilizes a small transverse incision at the level of the Achilles tendon rupture to introduce a device that allows for sutures to be passed through the ends of the tendons to re-approximate the ends of the tendons indirectly. Benefits include a smaller incision with a diminished risk of wound complications. Because there is no disruption of the paratenon, there is a theoretical benefit of less disruption to the blood supply as well as less disruption to the ability of the tendon to glide. Risks of the mini-open procedure include a higher rate of iatrogenic nerve injury, and in some studies there is a tendency towards a higher re-rupture rate compared with the traditional open repair. This is attributed to a weaker repair in the percutaneous repair compared to that of the open repair.

RECOVERY

Following treatment (both surgical and non-surgical):

  • Your leg will be in a cast or special braces for several weeks.
  • If you have a cast, keep your cast dry! If the cast gets wet, the skin underneath stays damp and can become mouldy and smelly. To keep your cast dry in the shower, enclose it in a plastic bag, or buy a special cast protector. If the cast and the underlying dressing get wet, contact your surgeon’s office or go to your nearest emergency department to get your cast checked.
  • You will be instructed on caring for your cast or brace, and if and how much weight you can bear on the foot.
  • Watch for complications after surgery. Alert your surgeon or visit an emergency room if you experience
  • pain that does not subside with prescribed medication, swelling that worsens (or the cast becomes too tight and you notice loss of colour in your toes), and/or have a fever higher than 38°C or 101°F.

Both surgical and non-surgical treatments traditionally require an initial period of about 6 weeks of casting or special braces. The cast may be changed and foot repositioned every 2 to 4 weeks to slowly stretch the tendon back to its normal length. Bracing may be combined with early movement (1 to 3 weeks) to improve overall strength and flexibility. At approximately 6 weeks, you may be able to begin bearing some weight on the foot. A heel-lift device and regular physiotherapy are part of the treatment. It takes at least 4 to 6 months before it is safe to return to activities such as running.

Some studies have shown that patients do well and heal faster with more rapid mobilization. If a solid repair is attainable, patients may not be casted at all and may be allowed to begin motion immediately after surgery. These patients will use a removable boot when walking for about 3 weeks. Your surgeon will discuss the details of your particular situation with you.

ACHILLES TENDON REHAB PROTOCOL