SURGERY FOR THE INSERTION OF THE ACHILLES TENDON
The Achilles tendon insertion and the inflamed heel
What is it?
The Achilles tendon attaches to the heel bone (the calcaneus) over a very broad area. Although the tendon is only approximately one-centimeter thick, it’s attachment spreads over a three and a half-centimeter area on the calcaneus.
Recurrent stress on the tendon where it attaches (the insertion) leads to inflammation, microscopic tearing of the tendon, swelling and pain.
This swelling can be associated with inflammation of the space between the tendon and the calcaneus, called the retrocalcaneal bursa. At times the back of the heel can begin to enlarge and get quite thick. The thickening is partly as a result of bone spurs that may develop on the back of the calcaneus which can then grow up into the substance of the Achilles tendon causing further wear and tear of the tendon.
Treatment of the insertion of Achilles tendonitis commences with rest, elevation of the heel on the sole of the shoe, and physical therapy treatments. All of these are designed to decrease the inflammation on the tendon that occurs when walking, since this stretches the Achilles tendon.
Further modalities for treatment include shockwave therapy, prolotherapy and platelet rich plasma (PRP) however outcomes of these treatments are not always guaranteed leading to surgery.
General Recovery Facts
- A 3-6 cm incision is made on the inside of the heel.
- Following surgery, you will need to use crutches for 2-4 weeks.
- Driving is permitted at 2 weeks if it is the right foot, and about 3 weeks if the left foot.
- At the first office visit, you will be able to start walking in either a cast or a removable walking boot.
- The boot is worn for 4-6 weeks, and then you are able to wear a shoe.
- The shoe should have an open back to prevent rubbing on the heel and tendon. You will be better with this shoe for about one month in addition to potentially needing a compression sock to aid with swelling.
- Physical therapy is of paramount importance as a part of your recovery.
- You can expect swelling and tenderness at the back of the heel for about 3-4 months after surgery.
- You may experience a variety of sensations whilst in the cast consisting of sharp shooting, dull aches, electric shocks, throbbing, sensation of itching and these are all normal and you should not panic.
- You will also be placed on DVT prophylaxis as there is a risk of blood clots shooting to the lungs with this procedure for a period of 6 weeks.
Before & After Pics
3 months post op
Specific post-operative recovery
- Foot is wrapped in a below knee cast.
- Elevate the leg on some pillows when awake however when sleeping elevate the base of the bed with 2 bricks or thick books so that the limb does not fall of the pillow at night and you wake up swollen.
- Take pain and DVT prophylaxis medication as prescribed.
- Expect numbness in foot 4-12 hours, followed by pain for usually one more day.
- Do not allow foot to hang down.
- If you are travelling, move the toes as much as possible to stimulate the calf muscle however travel during this time is not advisable.
- First follow-up in the office.
- Cast inspection for any possible complications or irritable areas +- adjustment of cast.
- Start full weight-bearing in cast with post-operative shoe and crutches initially.
- Can allow foot to hang down at 3 weeks provided no pain and swelling occurs.
- Cast is removed by my dressing Sister and wound inspected.
- Moon boot is now applied for a further 4-6 weeks progressing to full weight-bearing without the aid of crutches.
- If incision is dry and completely healed, swimming is permitted for rehabilitation purposes taking care to not jump in the pool or apply any unnecessary force.
- Gentle exercise on bicycle permitted preferably guided by physiotherapist.
- If swelling is problematic you may require the use of a compression sock.
- Start physical therapy under supervision with my protocols and this will focus on scar desensitisation and tendon glide mostly until pain-free range of motion is achieved at which point biokinetics will commence.
- More vigorous exercise with Biokineticist for the next 8-12 weeks in order to achieve strength within 10% of the unaffected side hence clearing you for return to sport.
- Can discontinue boot at this stage and use a shoe with a supportive sole and a slight heel lift (heel cup) inside the sole of the shoe.
- Flat running on treadmill by 5-6 months.
- Followup in my consultation rooms.
- Photographs and video taken of range of motion and strength.
- Cutting sports by 9 months to a year.
May require gait analysis and custom orthotics to be made on an individual basis.
- Final followup in my consultation rooms.
- Photographs are taken of range of motion and strength.
- Patient outcome score taken.
- Swelling and residual weakness can often be expected up until this point.
- Patient is usually discharged at this stage.