Achilles Tendon Tear: What Is It?
Achilles Tendon Tear or the rupture of the achilles tendon typically occurs while playing sports or from a misstep. A strong contraction of the muscle excessively loads the tendon and it results in a tear. The patient often describes the sensation that something struck the back of the leg. Pain is suddenly present, and walking is painful and the leg is weak.
While it is possible to treat this ruptured tendon without surgery, this may not be ideal. Surgical correction of the ruptured tendon may be recommendable.
The surgery is performed in order to regain as much as possible the normal strength of the Achilles during push off. Regaining optimum strength depends on establishing the correct tension between the muscle and the tendon.
Following the tendon repair no walking on the foot is permitted for two weeks, then walking is begun in a removable boot. The design of this boot is important, and the positioning of the foot will be controlled in the first several weeks after surgery.
Repairing an Achilles Tendon Tear: PARS Achilles Jig System
In the last 10 years, there have been significant, new developments in the operative treatment of complete Achilles tears (also known as ruptures). There are now minimally invasive options that use significantly smaller incisions. Combined with a jig that allows for percutaneous passage of the suture material, the risk of wound problems, including infection, is reduced. Given that the main risk of surgical treatment of Achilles ruptures is the healing of the incision itself, this minimally invasive technique is thought to decrease risk significantly.
The Pars Jig (Arthrex), which Dr. Dominic Carreira uses in his practice, is designed specifically to avoid nerve injuries, especially to the sural nerve. The time for recovery is essentially the same as with an open surgery with a traditional incision.
In order to perform a successful surgery, the suture material passed percutaneously through the skin must have significant purchase of this tendon itself. For this reason, Dr. Carreira also consents his patients for an open technique, for the rare circumstance that a formal incision needs to be made in order to appropriately grasp tendon material.
Risks of Achilles Surgery
The main risk with Achilles surgery is related to wound problems and infections. For this reason, smaller incisions are generally advantageous, thus the PARS Achilles Jig System is attempted. Depending on the length of the injury and the length of time that has passed since the tear occurred, the incision can be minimized.
Recovery from Achilles Surgery
Generally speaking, the recovery from Achilles surgeries only 2 weeks of non-weight bearing. After that time, an Achilles boot with wedges can be used to offload the Achilles and prevent overstretching and potential rupture. This allows patients to bear weight at 2 weeks after surgery in the majority of cases. As such the time off due to weight-bearing is much shorter than what was traditionally advised, which is 6 weeks.
General Recovery Facts
The goal of surgery is to regain strength and function in as short a time as possible. You will need to use crutches for approximately two weeks after surgery. Once the sutures are removed, walking in a removable boot will be started. Walking and exercise are very important to regain strength after surgery and a careful physical therapy program and rehabilitation protocol is outlined below:
- Foot wrapped in bulky bandage and surgical splint
- Ice, elevate, take pain medication
- Expect numbness in foot for 12-24 hours, then pain will increase
- Use crutches for a approximately 2-3 weeks
- First follow up in the office
- Dressing changed, and boot is worn in equines (foot pointed downward)
- Plantarflexion (downward movement of foot) is allowed
- Write out alphabet with foot twice a day
- Start full weight bearing in boot
- If incision is dry, swimming is encouraged at 2 3 weeks
- Gentle exercise on bicycle with boot
- By 6 weeks the boot comes up to a neutral position, with gradual progression to this position completed by the removal of inserts from the boot
- Start physical therapy under supervision
- Gradually wean from boot into open back shoe
- Walking is the most important form of therapy at this point