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Achilles Repair

The Achilles tendon is susceptible to rupture, a condition that can significantly impair mobility and quality of life. This tendon, the largest and strongest in the human body, connects the calf muscles to the heel bone, playing a pivotal role in walking, running, and jumping. Ruptures can occur due to a variety of reasons, including sports injuries, falls, or degenerative changes, especially in older individuals and those with certain medical conditions.

Studies have demonstrated good functional results and patient satisfaction with both surgical and nonsurgical treatments. Surgery is commonly preferred by younger, athletic individuals who lead active lifestyles, whereas older adults tend to select nonsurgical options for treatment.

The decision between surgical and nonsurgical treatment should be a collaborative process involving the patient, and their Silicon Valley Orthopedics orthopedic surgeon. It’s important to consider the patient’s lifestyle, expectations, and willingness to adhere to a rehabilitation program. Full understanding of the potential risks and benefits of each approach is essential.

The primary goal of nonsurgical treatment is to restore as much function as possible and prevent further injury to the tendon. The specific protocol may vary based on the patient’s age, general health, activity level, and the nature of the tendon rupture.

Nonsurgical treatment typically involves several key steps focused on allowing the tendon to heal without surgical intervention. Initial management is RICE – rest, icing, elevation, pain control and immobilization using a cast, brace, walking boot, or similar device that keeps the foot in a flexed position, relieving tension on the tendon.

Patients may be advised to avoid putting weight on the affected leg. Over time, as healing progresses, they will be allowed to gradually bear weight using crutches or a walker, transitioning to full weight-bearing as tolerated.

Once the tendon has sufficiently healed to tolerate movement, physical therapy will begin. Early-stage rehabilitation focuses on gentle range of motion exercises to prevent stiffness. As healing progresses, strengthening exercises are introduced to rebuild the strength of the calf muscles and tendon.

As the patient transitions out of immobilization, heel lifts or orthotic devices may be used inside the shoe to continue reducing stress on the tendon as it finishes healing. The patient will slowly return to normal activities. High-impact activities, such as running and jumping, will be off-limits until the tendon has fully healed and regained strength. In addition to formal physical therapy, the patient will likely be given exercises to do at home to aid in recovery. Patients might need to take precautions indefinitely, such as wearing supportive footwear, to prevent re-injury.

Surgical repair is generally advised for active individuals, athletes, and those with a complete rupture. There are several techniques, but all involve physically stitching the torn ends of the tendon back together. Your Silicon Valley Orthopedics surgeon will make an incision at the site of the rupture, locate the torn ends, and suture them together.

  • Open surgery involves a single, large incision in the back of the leg. The tendon is debrided, removing damaged and degenerated tissues and then the torn ends are stitched together.
  • Mini open repair involves a small incision to debride the tendon, and the torn ends are stitched back together. Two other small incisions are made for bone anchors.
  • Minimally invasive repair involves a small incision, and a special device is used to suture the tendon with minimal incisions.

The use of regenerative medicine such as platelet -rich plasma augmentation during surgery may help active athletes may recovery their motion earlier and reduce the time to return to sports. Bone marrow aspirate concentrate has also improved clinical function and reduced foot and ankle pain without serious adverse effects.

The goal of surgical repair is early return to activity and to reduce the risk of re-rupture as compared to nonsurgical treatment. Overall, the healing rates between nonsurgical casting and surgical repair are similar.

The initial recovery phase after Achilles tendon surgery involves keeping the foot in a cast or boot to immobilize it, with minimal weight-bearing for up to six weeks, sometimes with the aid of crutches.

From six to twelve weeks, patients start bearing more weight and switch to a removable boot, while beginning gentle physical therapy exercises to regain motion. After three to six months, therapy focuses on strengthening and improving flexibility, with patients gradually resuming normal activities.

Typically, it can take anywhere from 6 months to a full year before an individual can return to all their pre-injury activities, including sports, at the same level of intensity.

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When you or a loved one has an ankle injury, contact Silicon Valley Orthopedics to schedule a consultation. We have offices in Fremont, Los Gatos and Menlo Park. At Silicon Valley Orthopedics we strive for compassionate, personalized care and treatment options geared to your needs.