If your Achilles tendinitis pain does not subside
after at least six months of conservative treatment,
your physician may recommend surgery to cut away
the damaged tissue and stimulate healing. If you
and your physician have decided on surgery to treat
your Achilles tendinitis, the decisions you make
and the actions you take before your surgery can
be every bit as important as the procedure itself
in ensuring a healthy recovery.
Prior
to your return home from the hospital, make sure
that you have received any equipment you will
need when you get home. This may include crutches
or household items to make movement around the
house easier. You should receive prescriptions
for any of these from your doctor before you go
home from the hospital.
Any
physical problems or changes in your overall health,
such as a fever or infection, should be reported
to your surgeon, and you should notify your surgeon
of any medications you are taking.
Understand
the potential risks and benefits of the surgery,
and ask your surgeon any questions that will help
you better understand the procedure. It can also
help to talk to someone else who has undergone
the same surgery.
If
possible, practice walking with your crutches
so you are ready to use them after surgery.
Getting
a second opinion from another qualified surgeon
is often advisable, particularly in rare or unique
cases.
To
check if the orthopedist performing the surgery
is board-certified or eligible, call the American
Board of Orthopaedic Surgery at (919) 929-7103.
At most medical centers, you will go to "patient
admissions" to check in for your operation.
There may be separate check-in areas for ambulatory
outpatient (patients who go home the same day after
surgery) and for overnight inpatient surgery, so
be sure to ask your doctor or an assistant about
this. After you have checked in to the hospital,
you will go to a holding area where the final preparations
are made. The mandatory paperwork is completed,
and your ankle area may be shaved, though this is
not always necessary. You will be asked to change
into a hospital gown and, if applicable, remove
your watch, glasses, dentures, and jewelry. You
will have the opportunity to speak with your orthopedic
surgeon or an assistant and meet the anesthesiologist
or nurse anesthetist (a nurse who has done graduate
training to provide anesthesia under the supervision
of an anesthesiologist). An IV (intravenous) line
may be placed in your arm at this time. Then, you
will walk or ride on a stretcher to the operating
room. Most patients are not sedated until they go
into the operating room. Here are some important
steps to remember for the day of your surgery:
You
will probably be told not to eat or drink anything
after midnight on the night before your surgery.
This will reduce the risk of vomiting while you
are under general anesthesia.
Since
you will most likely be able to go home within
a few hours of surgery, arrange for someone to
drive you home when you are released.
Wear
a loose pair of shorts, sweatpants, or other clothing
that will fit comfortably over your short leg
cast or splint when you leave the hospital.
Take
it easy. Keeping a good frame of mind can help
ease any nerves or anxiety about undergoing surgery.
Distractions such as reading, watching television,
chatting with visitors, or talking on the telephone
can also help.
Surgery to treat Achilles tendinitis usually takes
about 1 1/2 hours to perform. Though the surgical
debridement procedure ordinarily requires an open
incision, most patients can leave the hospital the
same day. Spinal anesthesia typically is given to
numb you from the waist down, and you are sedated
so you sleep through the procedure.
A
5-to-10-centimeter incision usually is made in
the back of your ankle, running along the inside
of your Achilles tendon.
Your
surgeon cuts away, or debrides, any damaged tissue
or calcium deposits. Debridement exposes healthy
tissue and encourages blood flow through the damaged
area to promote healing.
You
may need to have scar tissue removed from the
sheath surrounding the tendon, from the tendon
itself, or from a combination of both.
If
your Achilles tendon has been damaged where it
inserts into heel bone, your surgeon may need
to take some part of the tendon off its insertion
to debride the tissue. The healthy tendon tissue
is then sutured back down onto your heel bone.
Incisions
in your tendon sheath and skin are closed with
stitches and your ankle is put into a splint to
immobilize it. You are then taken to the recovery
room.
Recovery
Room
After surgical debridement of your Achilles tendon,
you will be transported to the recovery room where
you will be closely observed for one to two hours
while the immediate effects of anesthesia wear off.
Your ankle will be immobilized in a splint or cast
when you wake up, and your ankle will be elevated.
After surgery, you usually experience some pain.
Adequate pain medications will be prescribed for
you. You will be given intravenous (IV), oral, or
intramuscular pain medications as needed. Your surgeon
will prescribe crutches and you are usually instructed
to keep weight off your ankle for the first two
weeks. Your temperature, blood pressure, and heartbeat
will be monitored by a nurse who, with the help
of your physician, will determine when you can prepare
to go home. You will normally be able to leave the
hospital or clinic within three to four hours after
surgery. Make sure to have someone available to
drive you home, as you will be unable to drive a
car.
Because physicians generally recommend that you
avoid putting any weight on your foot and ankle
until your incision has healed, you may have to
use crutches for about two weeks after surgery.
Rest as much as possible with your ankle elevated
above your heart level. This helps blood drain
away from your ankle and can control swelling.
For two or three days after surgery, most patients
are instructed to stay off their feet and rest.
You may be able to get around more after about
three days, but you should continue to elevate
your ankle as much as possible and use your crutches
to keep weight off your ankle. You may need to
use pain medication prescribed by your physician
for one or two days after surgery. Pain usually
decreases within a few days. It can be helpful
to have someone around the house who can assist
with any physical chores. Patients commonly return
to their physician’s office within 10-14
days to have the sutures removed.
BRACES
If you only had damage in your tendon sheath,
your foot and ankle will probably be put into
a removable brace called a cam walker, which helps
relieve pain as you begin walking. A cam walker
is a type of boot splint made of nylon straps
that secure around your lower leg and foot to
hold your ankle in place. There is usually an
adjustable ankle hinge that can be set to allow
some limited ankle motion. If your Achilles tendon
itself was damaged, you may be put into a short
leg walking cast for two to four more weeks. To
keep the cast dry, either wrap a plastic garbage
bag around the cast while showering or bathe with
your leg out of the tub.
When the cast comes off, most patients wear a
cam walker until their pain subsides. When you
begin wearing a cam walker, you should remove
it three times a day to perform range of motion
exercises. Prop your leg up on a stool or pillow
so your ankle is off the floor. Physicians generally
recommend moving your ankle up, down, and side-to-side.
Start with slow movements and do not move your
ankle too far in any direction. Many patients
can strengthen their ankles without formal physical
therapy. Your physician generally evaluates your
ankle after four to six weeks and determines whether
regular cardiovascular exercise and everyday weight
bearing can sufficiently strengthen your ankle.
Depending on how much tissue your surgeon had to
remove from your Achilles tendon, you may need three
to four months to strengthen the Achilles tendon
until it is back to normal. Generally, patients
can recover adequate ankle strength by walking around
and performing some simple stretching exercises
at home. However, based on how fast you improve
and how much exercise you are doing on your own,
your physician may refer you to a supervised physical
therapy program. Athletes and people who want to
return to physical activities as quickly as possible
also may benefit from supervised training. A physical
therapist can administer massage and heat therapy
to soothe pain. However, massaging and applying
heat to an injured ankle can disrupt the healing
process. Your physician will decide when it is safe
to begin ankle massage. Strengthening exercises
usually start within a month. Initially, you will
probably perform light exercises, including picking
objects off the floor with your toes and flexing
and extending your ankle. The resistance gradually
increases as your tendon heals. You can usually
return to activities when the range of motion and
strength are equal in the injured and healthy ankle,
when you can jog, sprint, and cut side-to-side without
pain, and you can jump and land without pain.
Because overuse and overtraining puts you at high
risk for recurring Achilles tendinitis, physicians
generally recommend that you avoid repetitive activities
that put constant strain on your Achilles tendon.
If your tendinitis was caused by running or other
endurance activities, you may want to cut back on
your previous activity level. Try to incorporate
cross-training into your workout schedule. For example,
instead of running every day, alternate between
running and swimming workouts. Warm up before participating
in activities and stretch your calf muscles, Achilles
tendons, and feet both before and after activities.
You should increase the duration and intensity of
your workouts by no more than 10 percent per week
and avoid serious sprinting and hill climbing until
you have worked up to a high fitness level. Choose
athletic shoes that properly fit the shape of your
foot. Continue to wear orthotic inserts and heel
lifts if recommended by your physician. If your
ankle starts to hurt during exercise, you should
return to your physician’s office for a check-up.
Prior
to your return home from the hospital, make sure
that you have received any equipment you will
need when you get home. This may include crutches
or household items to make movement around the
house easier. You should receive prescriptions
for any of these from your doctor before you go
home from the hospital.
