Achilles tendon surgery

The Achilles tendon is most often ruptured as a result of a major force injury. It is more rarely ruptured as a consequence of smaller forces due to the structural changes which are caused by the degeneration of the tendon. Occasionally, the tendon gets detached from the heel bone with a bony base.

What causes Achilles tendon ruptures?

• The Achilles tendon is the strongest tendon in the human body; it connects the calf muscles with the heel bone. It has an essential role in walking, running, and jumping.
• As a consequence of overload, the tendon wears out and microinjuries develop in it. Generally, when starting to walk suddenly or when changing directions, the sudden load could make the patient feel as if someone kicked them, following which some level of walking inability develops.

What are the main symptoms of the disease?

• Pain which is characterized by:
  • Sudden pain
  • Increases on load
• Reduced movement, swelling, limping
• Reduced ability to walk and walking distance
• Inability to standing on tiptoes
• The interrupted continuity is palpable

What are the treatment options?

Basically, there are two types of treatment options available:

Non-surgical (conservative) treatment

Indication:

• It is mainly recommended in case of a partial rupture.
• If the surgery has to be postponed due to concurrent diseases, or if it poses a higher risk due to poor general condition.

Methods:

• Plaster casting, adjustable boots/boots with orthopedic heels, or the combination of these. Unloading with crutches followed by physiotherapy.
• Complications occur substantially rarer during conservative treatment, but the mean risk of a repeated rupture is 20% according to the literature.

Surgical treatment

Physicians usually recommend surgery. The risk of a repeated rupture following surgery is only 4% according to the scientific literature but restoring the previous flexibility and strength of the Achilles tendon cannot be guaranteed even with prudent surgery.

• Closed (percutaneous) technique:
  • if it is applicable (healthy tendons, rupture of the mid third), it has substantially lower complications indicators and risks as opposed to the open technique.
  • The ruptured ends are sewed with a special suture technique from 3 incisions of half a centimeter each, arranged in two rows at a certain distance, then a knot is tied by pulling them together under the skin.
• Open technique:
  • It is generally recommended in the case of larger rupture, and ruptures which are accompanied by small tendon stumps from the heel bone or the calf musculature.
  • The tendon is sewed with eye control from a longitudinal incision by opening the tendon sheath.
  • If the tendon stumps do not touch, they are strengthened by braiding in an accessory tendon, or using a so called tendon flap from the calf.
  • Implants are very rarely used, mainly in case of bony ruptures.

The surgical process:

• The tendon is explored according to the closed or open technique.
• One of the above described surgeries are performed.
• A suction drain made of silicone is inserted in the surgical site due to the bleeding that comes with the surgery.
• The wound is closed following prudent surgical hemostasis.
• Cover dressing and elastic bandage are applied, followed by a plaster cast or plastic boots.

What happens if the justified surgical treatment is not performed?

• The pain is expected to increase further.
• The movement disability may aggravate.
• The quality of life keeps deteriorating.
• The effectiveness of a surgery performed later may decrease.