How is the Surgery Performed?

Surgery for the Achilles Tendon may be carried out because the tendon has snapped, or because there is wear and tear within the tendon that has not responded to physiotherapy.

Surgery is performed with the patient anaesthetised and facing downwards to expose the calf and Achilles tendon.

If the tendon has snapped, the ends are put back together through minimally invasive surgery. The repair has to be protected as stretching the tendon  - by allowing the foot to bend upwards - will risk tearing apart the repair. A special boot is applied straight after surgery to protect the repair.

If the tendon has wear and tear pain without snapping, then surgery aims to increase the amount of blood going into the tendon. This is achieved by making cuts into the outer border of the tendon, to encourage healing within it.

Surgery is carried out under general anaesthetic, but can be augmented with local anaesthetic injections behind the knee or around the ankle. The injections are normally given while you are asleep for your comfort. They can give good pain relief for the first day after the operation. You can go home the same day in the evening.

Risks of Surgery

Specific risks of Achilles Tendon surgery include re-rupture (5%) and wound breakdown (1%). These are increased in smokers. In Achilles tendinopathy surgery, the specific risks are rupture, continued pain and wound breakdown. Other risks include bleeding, infection, poor bone healing, poor skin healing, injury to tendons, injury to nerves, recurrence, and a need for further surgery.

There is a small risk of blood clots in the legs or lungs (DVT and PE), and there are also risks from anaesthesia - the process of being put to sleep for your operation.

Risks of Anaesthesia

The injection behind your knee is given using an ultrasound machine to guide the needle. There is a less than 1% chance of injury to the nerve. General anaesthetic also carries risks. These risks are proportional to your general health. You will need to be assessed for your fitness for surgery and an Anaesthetist will be able to advise you on your individual risk.

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