LONDON FOOT & ANKLE SURGERY
Mr Andy Roche MSc FRCS (Tr & Orth) Consultant Orthopaedic and Trauma Surgeon specialising
in Foot and Ankle Surgery and Reconstruction

Achilles Tendon Rupture Repair

How the surgery is carried out

It is a daycase operation. The operation is done under a general anaesthesia and an added injection around the area to numb it after surgery. The operation involves a small incision (5cm) over the Achilles tendon, if done minimally invasively using the device below this still requires an incision, only smaller still. The procedure involves carefully reattaching the tendon ends with a strong suture that will not need to be removed later on. Dissolvable skin stitches may be used but your surgeon will inform you if not.

Achillon

What to expect immediately after surgery in hospital

You will be given adequate pain relief medication. You will be in a below the knee plaster cast. Your physiotherapist will advise on mobility non-weight bearing on the leg during your stay. You will be discharged when you are comfortable and given a follow-up out-patient appointment. 

Recovery in the first few weeks after surgery

  • Elevate you foot as often and as much as possible to reduce swelling.
  • Mobilise as instructed by the physiotherapist, but only for necessity indoors and outdoors.
  • Some blood ooze can be expected in the bandage, if worried contact the Consultants clinic.
  • Take pain-killers as prescribed.

Post-operative clinic schedule

  • 2 weeks - wound check and application of boot
  • 10 weeks - clinical review once foot is comfortably flat on the ground
  • 20 weeks - possible return to full function

When can I start to walk?

  • 0-2 weeks - Plaster cast, non-weight-bear with crutches
  • 2 weeks onwards - In a boot, weight bear as tolerated with/without crutches and build up slowly with physiotherapy assistance

Physiotherapy and Rehabilitation

The physiotherapist will follow the rehabilitation schedule on this website and guide you through the stages. It is vital that you adhere to the advice given to you. This schedule is only a guide and can vary between patients.

How do I wash and shower?

Keep the plaster cast totally dry. You may shower with a waterproof cover over the plaster. Once the plaster is removed you may shower if the wound is healed but gently dab the wound dry. Be careful not to stumble on the ankle out of the boot.

How can I look after the incision wound?

Once out of cast, do not pull at scabs but let them fall away naturally. If your wound becomes red, swollen or sore you need to see your Consultant to ensure there is no infection present. Your physiotherapist may advise on wound massage.

When can I start to drive again?

DVLA states it is the responsibility of the driver to ensure they are always in control of the vehicle. A good guide is if you can stamp down hard with the foot to stop the car in an emergency stop. This will take at least 10 weeks. Click here to read DVLA guidance.

When can I work?

This is very individual and job-dependent. Below is a guide:

  • Sedentary 4 weeks
  • Manual labour 12-16 weeks 

What long-term outcome can I expect after surgery?

Full range of movement to the ankle with normal power and function and full return to sports and previous activities. The timing of which can vary between individuals. Return to high level sports can take between 6 to 9 months, return to a more sedentary lifestyle between 4-6 months. Overall outcome is very good in the majority of patients with over 90-95% being very pleased.

What are the risks?

Any operation carries a risk. Below is a guide to some risks potentially encountered. It is the surgeons duty to fully inform you of possible risks. Mr Roche will ensure this is always done so patients can make safe and informed choices about their operation.

Infection

If happens, in around 5%, it is usually simply treated with antibiotics. Significant consequences from infection are very rare but can be dealt with.

Nerve damage

Nerves that supply sensation to the skin are near the incision site. Damage is rare but if your toe or outside of foot stays numb after surgery, the nerve may be bruised. If so it usually recovers. Risk is <5%.

Re-rupture

Often due to a repeated injury or stumble. You will need to seek urgent medical attention to discuss whether re-operation is a good option. Re-rupture occurs in between 2-5%, but current “accelerated movement and weight-bearing rehabilitation” techniques may reduce the risk.

Deep Vein Thrombosis

Symptomatic clot formation in the leg is unusual after Achilles surgery (2-5%). Some patients can develop clots that cause no problem whatsoever. Whether treatment to prevent clot is needed can be discussed with your surgeon. There is no consensus amongst UK Orthopaedic surgeons as to whether preventative medicine is needed.

Important last note

This document is only meant to be a guideline to help you understand your treatment and what to expect. Every person is different and your rehabilitation may be quicker and slower. This will be advised and guided by your doctor and physiotherapist.

  • Chelsea & Westminster Hospital NHS
  • The Lister Hospital, Chelsea
  • Fortius Clinic
  • Bupa Cromwell Road