Surgery to repair a ruptured Achilles tendon typically
is the best option for patients who want to return
to a high level of sports and activities. Surgical
repair can help you recover fully from a rupture
with a lower risk of re-rupturing your Achilles
tendon. v=PAT&doc_id=29" target="_new">William
G. Hamilton, M.D., team physician for the New York
Knicks and New Jersey Nets.
If you and your physician have decided on surgery
to treat your Achilles tendon rupture, 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 new medications you are taking.
Learn
the potential risks and benefits of the surgery
by asking 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.
v=PAT&doc_id=29" target="_new">William
G. Hamilton, M.D., team physician for the New York
Knicks and New Jersey Nets.
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 go home the same day after
surgery) and for overnight inpatient surgery. 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 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). 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 things 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 or regional 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 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.
v=PAT&doc_id=29" target="_new">William
G. Hamilton, M.D., team physician for the New
York Knicks and New Jersey Nets.
Surgery
Procedure
Open surgical repair of a ruptured Achilles tendon
usually takes about an hour to perform. Though the
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 usually are sedated
so you sleep through the procedure.
An
incision about 10 centimeters long is made in the
back of your ankle, running along the inside of
your Achilles tendon, up from your heel.
Your
surgeon opens up the sheath covering your Achilles
tendon.
A
running stitch usually is used to weave the tendon
ends together. Two sutures are made, one along each
side of your Achilles tendon. The two sutures are
tied together to pull the ruptured ends of your
tendon together.
Surgeons
typically gauge the tension of your Achilles tendon
in your repaired side and make it equal to the other
side.
Incisions
in your skin usually are closed with stitches and
your ankle is put into a splint to immobilize it.
You are then taken to the recovery room.
v=PAT&doc_id=29" target="_new">William
G. Hamilton, M.D., team physician for the New York
Knicks and New Jersey Nets.
After your ruptured Achilles tendon is repaired,
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 plaster
splint when you wake up and your ankle will be
elevated. The splint usually holds your ankle
in a slightly bent downward position. 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 the doctor, 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. v=PAT&doc_id=29" target="_new">William
G. Hamilton, M.D., team physician for the New
York Knicks and New Jersey Nets.
Home
Recovery
Physicians generally recommend that you avoid bearing
weight until your incision has healed. Crutches
may be prescribed for about two to four weeks after
surgery. Rest as much as possible with your ankle
elevated above the level of your heart. 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. Part of the risk of surgery is a wound complication
after your Achilles is repaired. Though it happens
in less than one percent of patients, your ankle’s
blood supply may not be as good as other body parts
and you may be prone to wound problems. Because
you cannot see your incision inside the cast, it
is important to notify your physician if you feel
discomfort. To prevent complications, your physician
checks your incision at two weeks to see how it
is healing. Over the course of six weeks, you go
back to your physician for new casts and ankle braces
until your foot is brought up to a neutral position,
where your ankle is not bent. Though every physician
has a slightly different way of treating Achilles
tendon ruptures after surgery, the general schedule
is as follows:
Two
weeks – Return to your physician to have the
stitches taken out and receive a new cast that immobilizes
your foot in a slightly bent-downward position.
Four
weeks – Your physician may bring your foot
up to an almost neutral position (foot perpendicular
to your leg) in either a walking cast or brace,
called a cam walker. You often can begin bearing
some weight on your ankle.
Six
weeks – Begin wearing a cam walker or supportive
shoes with an orthotic heel lift and bearing more
weight on your ankle.
Your physician may prescribe range of motion exercises
for you to perform at home after your cast is removed.
The goal is to avoid pain and stimulate blood flow
and circulation. Patients generally are instructed
to remove their ankle brace for a brief period and
prop their lower leg 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. v=PAT&doc_id=29"
target="_new">William G. Hamilton,
M.D., team physician for the New York Knicks and
New Jersey Nets.
After surgery, most patients are able to rebuild
their ankle strength and return to sports and activities
within five or six months. Your physician may recommend
a physical therapy program depending on how much
progress you make performing range of motion exercises
on your own. You typically progress from range of
motion exercises to light cardiovascular exercise
and then strengthening exercises. If you experience
episodes of minor swelling or pain while exercising,
have your physician examine your ankle. Physical
therapy usually involves learning an ankle stretching
routine and performing foot and lower leg strengthening
exercises. The following stretching exercises are
commonly prescribed:
Preventing re-rupture of your Achilles tendon may
initially require caution during sports and activities.
Your physician typically follows your progress for
about six months. If you can make it through six
months of rehabilitation without any Achilles tendon
problems, your tendon probably has healed and you
should be able to return to a normal level of sports
and activities. The goal after surgery is to return
your repaired Achilles tendon to the strength of
the uninjured side. Once you accomplish this, your
risk of re-rupture usually diminishes. Sports that
require quick starts and stops, sprinting, and jumping
may increase your risk of reinjury. 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 unless
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. v=PAT&doc_id=29"
target="_new">William G. Hamilton,
M.D., team physician for the New York Knicks and
New Jersey Nets.
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.
