In some cases, the Achilles tendon can tear, or rupture. This is usually due to a sudden, strong force. It can happen during tough physical activity. It can happen if you suddenly move faster or pivot on your foot. Having a foot that turns outward too much can increase your risk of a torn tendon. A ruptured Achilles tendon can cause pain and swelling near your heel. You may not be able to bend your foot downward. The Achilles tendon can also degenerate. This is also known as tendinitis or tendinopathy.
This might cause symptoms like pain and stiffness along your Achilles tendon and on the back of your heel. This is most often through overuse and repeated stress to the tendon. It can result from repeated stress on your tendon, especially if you have recently been more active. Having short calf muscles can increase your risk of tendinopathy.
During the surgery, an incision is made in the back of the calf. If the tendon is ruptured, the surgeon will stitch the tendon back together. If the tendon is degenerated, the surgeon may remove the damaged part of the tendon and repair the rest of the tendon with stitches.
If there is severe damage to a lot of the tendon, the surgeon might replace part or all of your Achilles tendon.
This is done with a tendon taken from another place in your foot. In some cases, the Achilles tendon repair surgery can be done as a minimally invasive procedure. This is done with several small incisions instead of one large one. It may use a special scope with a tiny camera and a light to help do the repair. You might need Achilles tendon surgery if you tore your tendon.
Surgery is advised for many cases of a ruptured Achilles tendon. But in some cases, your healthcare provider may advise other treatments first. These may include pain medicine, or a temporary cast to prevent your leg from moving. And your healthcare provider may not advise surgery if you have certain medical conditions.
These include diabetes and neuropathy in your legs. Or you may need Achilles tendon repair surgery if you have tendinopathy.
But in most cases, other treatments can be used to treat tendinopathy. These include resting your foot, using ice and pain medicines, and using a brace or other device to stop your foot from moving.
Physical therapy can also help. If you still have symptoms after several months, your healthcare provider might advise surgery. Key points to remember You can treat an Achilles tendon rupture with surgery or by using a cast, splint, brace, walking boot, or other device that will keep your lower leg and ankle from moving immobilization.
Both surgery and immobilization are usually successful. Another rupture is less likely after surgery than after immobilization. But immobilization has fewer other risks. The success of your surgery depends on many things, including how badly your tendon is damaged, how soon after your rupture you have surgery, and your rehabilitation program after the surgery.
If you are younger or are physically active in sports, at work, or at home, surgery is often advised. If you are older or are inactive, immobilization is often advised. What is the Achilles tendon, and what is an Achilles tendon rupture? How well do treatments work? The success of your surgery depends on: Your surgeon's experience. The type of surgery you have percutaneous or open surgery. How badly your tendon is damaged. How soon after the rupture your surgery is done.
How soon your rehabilitation rehab program starts after surgery. How well you follow your rehab program. What are the risks of surgery? A review of small studies of surgeries done within 3 weeks of an Achilles tendon rupture showed: Among people who have surgery, up to 5 out of may have another rupture after surgery.
Up to 18 out of people who had open surgery had an infection, and there were no infections after percutaneous surgery. Infection is possible with any surgery, but it is more common with open surgery.
The small risk of other complications was about the same with either open or percutaneous surgery, and most problems go away over time. These complications included pain, delayed wound healing, nerve damage, and problems with scarring. What are the risks of immobilization? Why might your doctor recommend surgery for a ruptured Achilles tendon? Your doctor may advise you to have surgery if: You are physically active in sports, at work, or at home. You have a job that requires leg strength.
Compare your options. Compare Option 1 Have surgery for Achilles tendon rupture Treat the rupture with a cast or brace immobilization.
Compare Option 2 Have surgery for Achilles tendon rupture Treat the rupture with a cast or brace immobilization. Have surgery for Achilles tendon rupture Have surgery for Achilles tendon rupture You will most likely go home the same day as surgery. You will spend 6 to 12 weeks after surgery wearing a walking cast or boot. If you sit at work, you can go back in 1 to 2 weeks. If you're on your feet at work, you may need 6 to 8 weeks before you can go back.
Your total recovery time can be up to 6 months. Surgery repairs the tendon and makes another rupture less likely. You can go back to work and resume daily activities sooner than with immobilization. All surgery has risks, including bleeding and infection.
Your age and your health can also increase your risk. You may have: Minor pain and temporary nerve damage. Slight risk of deep vein thrombosis or permanent nerve damage. A small risk of repeat tendon rupture. Treat the rupture with a cast or brace immobilization Treat the rupture with a cast or brace immobilization You'll wear a cast, splint, brace, walking boot, or other device for several months.
Immobilization allows you to avoid surgery and the risk of wound infection. You may have: Repeat tendon rupture. Loss of strength in the leg. Minor pain and temporary nerve damage. A very slight risk of deep vein thrombosis or permanent nerve damage. Personal stories about surgery for Achilles tendon rupture These stories are based on information gathered from health professionals and consumers.
What matters most to you? Reasons to choose surgery for a ruptured Achilles tendon Reasons to choose a cast or brace immobilization to treat a ruptured Achilles tendon. I don't want to risk having another tendon rupture. My job requires that I have strong legs. My job doesn't require that I have strong legs. I'm not worried about the risks of surgery. I'm worried about the risks of surgery. I'm an active person, and I want to stay active.
The long recovery time does not bother me. My other important reasons: My other important reasons:. Where are you leaning now? Having surgery Immobilization. What else do you need to make your decision? Check the facts. True You're right. The costs associated with surgical repair are undoubtedly higher as well.
While this should not be a decision-making factor in recommending a course of treatment to our patients, the cost efficiency of medical care is an increasingly studied metric by government agencies and the commercial insurance sector. Finally, it is possible that more recently available injectable biologic treatments such as amniotic tissue, stem cells, extracellular matrix, etc. For many patients and possibly for the majority of acute Achilles tendon ruptures, non-surgical care via functional bracing and rehabilitation will yield consistently good reliable outcomes.
Loshigian has been in private practice in New York City since Epidemiology of Achilles tendon ruptures: increasing incidence over a year period.
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