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Achilles Tendon Surgery And What You Need to Know

Achilles Tendon Surgery And What You Need to Know
Achilles Tendon Surgery And What You Need to Know

Your Achilles tendon helps you walk, jump, and run, so injury to it can be quite debilitating. Treatment for an Achilles tendon tear or an Achilles rupture may require surgical intervention by an experienced lower extremity specialist to help restore its function and integrity.

If you experience an Achilles tendon injury and require Achilles Tendon Surgery, you and your healthcare provider will first discuss the risks and benefits of surgical versus non-surgical treatment. Depending on specific characteristics of your injury, your orthopedic surgeon may recommend surgical treatment.

What Is Achilles Tendon Repair Surgery?

Achilles tendon surgery repair involves mending the ends of a torn or ruptured tendon. The type of surgery will depend on where the Achilles tendon has torn.

  • If the tendon is torn above where it attaches to the bone, it will be repaired by reconnecting the two ends with a heavy suture.
  • If the tendon has torn off of the the heel bone, then the free end of the tendon will be reattached directly to the bone with special bone anchors.
  • In cases of significant surgical delay, your surgeon may have to augment the repair (make it stronger) by rerouting an adjacent tendon in your foot (tendon grafting).

Achilles tendon repair is usually done as a scheduled procedure for chronic tears and ideally performed within a few weeks of trauma at most.

This procedure is performed by an orthopedic surgeon, often with lower extremity experience and it can be done with an open approach or with a minimally invasive percutaneous approach that relies on several small incisions to repair the tendon with special instruments to bring the ends together.


Achilles tendon repair surgery isn’t the right solution for everyone.

Some relative contraindications include:

  • Active infection or a wound at the site of the repair
  • A history of blood clots or a new blood clot in the operative leg secondary to the injury.
  • Being on a blood thinner that can not be stopped during the perioperative period.
  • Pulmonary or cardiac disease may prohibit obtaining medical clearance.

It’s important to note that chronic tendon damage may result in scarring and shortening of the tendon, which can require a different treatment approach. Also, suppose you have a major illness or muscle atrophy. In that case, you might not be able to participate in postoperative exercises – full strength may not be restored even with surgery and therapy.

Potential Risks

Achilles Tendon Surgery can cause complications which are normally associated with anesthesia and surgery.

  • Infection and healing problems: Achilles tendon repair surgery can be complicated by a post-operative foot infection
  • Nerve injury: An injury during the procedure can potentially result in excessive bleeding or nerve damage.
  • Blood clot: The risk of a blood clot is higher with Achilles surgery compared with other surgical procedures and often will necessitate treatment.

Delayed risks include decreased calf mobility and stiffness due to post-surgical scarring.

There is also a risk of a repeat tendon tear after an Achilles tendon repair surgery, even if your surgery is successful.

Purpose of Achilles Tendon Repair Surgery

You might consider having Achilles tendon surgery if you have had a total or partial Achilles tendon tear or rupture. This can occur suddenly due to a sports injury or trauma, or it can develop gradually due to repetitive motion.

This type of injury can be diagnosed with a physical examination and non-invasive imaging tests. A torn Achilles tendon can cause pain, weakness, and swelling of the foot, so adequate treatment is necessary.

If you have a small tear that is likely to heal without surgery, your healthcare provider might recommend conservative management, such as resting your foot or wearing a cast or brace for several months so the tendon can heal on its own.

How to Prepare

If you experience a sudden traumatic Achilles tendon rupture, you may have swelling that could interfere with the surgical repair. If that is the case your healthcare provider might schedule your repair a few days or a week after your injury to maximize your chances of improvement.


Achilles tendon surgery is a scheduled outpatient procedure.

Food and Drink

You won’t have to make any dietary changes for your Achilles tendon repair surgery.


Your surgeon may adjust some of your regular medications before you have surgery; this could include blood thinners and anti-inflammatories.

Pre-Op Lifestyle Changes

Prior to your surgery, you will need to rest your foot to avoid additional injury and help reduce the swelling. This is critical if you are having surgery on a recent injury.

During Achilles Tendon Surgery

Your surgeon will begin your surgery by making an incision along the back of your ankle.

Your incision might be several inches long if you are having an open repair, or it can be less than an inch in length if you are having a percutaneous repair.

You will also have a layer of fascia (connective tissue) cut so your surgeon can access the tendon.

Your surgical team will be able to directly visualize the torn ends of your Achilles tendon if you are having an open procedure. Strong sutures are placed at both ends of the torn tendon to hold it together. These sutures are then tied together to repair the tissue.

Repair is optimized with the following methods:

  • Your surgeon will not stretch either end of your torn tendon too much to avoid tears from occurring during or after your surgery.
  • Generally, the sutures are placed in a strong section of the tendon that won’t be ripped by the suture, rather than a frayed or otherwise delicate edge.

If you need to have a tendon transfer, you will have a section of healthy tendon removed and sutured to the torn part of your Achilles tendon to lengthen and/or widen it for repair.

You will have bandages and surgical dressing placed on your wound.

A cast or brace will also be placed on your foot either before you leave the operating room or once you get to the recovery area.

After Your Achilles Tendon Surgery

Your medical team will ask about your pain levels and you will receive instructions about wound care, and also when it’s okay to place weight on your foot.


Your Achilles tendon surgery recovery starts with healing, wound care, and a period resting your foot. You will likely need to wear a cast or a removable boot for four weeks. Rehabilitation begins after several weeks of foot immobility and continues for several months.

Your own recovery schedule is based on the size of your incision, the severity of your tendon tear, and your surgeon’s overall assessment of your progress in healing.


During the healing phase after your Achilles tendon surgery, the key goals are to protect your wound and to identify early complications. You will need to make sure that you keep your wound clean and dry as instructed by your surgeon.

Signs of potential complications include:

  • Pain
  • Swelling
  • Bleeding
  • Warmth near your surgical site
  • Fever
  • Streaks of red on your skin near your cast or dressing
  • Oozing of fluid or pus

Lifestyle Adjustments

While staying active is highly beneficial for your health, it’s important that you are aware of the risks of further injuries after your initial Achilles tendon surgery. You can try to prevent getting injured by wearing the right shoes for the activities you’re doing and aiming for moderate and consistent activity, rather than infrequent high-intensity exercise.

Dr. Bagwe is a leading orthopedic surgeon specializing in ankle and foot reconstruction. If you are looking for an orthopedic surgeon near you then look no further. Dr. Bagwe is an industry leader when it comes to foot and ankle surgery doctors in St. Louis. Dr. Bagwe and his friendly and professional team is ready to welcome you and tell you everything you need to know.

Reach out and contact us today.

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