Ankle Surgery: Achilles Tendon Repair
The Achilles tendon is the largest and strongest tendon in the human body. When doing activities like basketball or tennis, it’s exposed to up to 10 times your body weight of force as you’re jumping or landing. It is what allows someone to participate in sports like basketball, tennis or soccer because it helps you jump, push off, run and be active.
There are essentially two different types of treatment – there’s surgery or surgical Achilles tendon repair, of which there are a couple different kinds – and then there’s conservative care or non-surgical, which is a very, very reasonable option for certain individuals. There are certain pros and cons to treating someone without surgery. There’s risk of infection in surgery. There’s slightly higher risk that the tendon can tear again. You might have a little more weakness when pushing off because it doesn’t heal quite as strong. With repairing an Achilles tendon tear, we take the two ends of the tendon, make an incision on the back part of the ankle, and take the two ends and reattach them directly.
The biggest advantage to surgery to repair an Achilles tendon is usually you wind up with an increased, almost normal strength of the calf muscle when pushing off. If you don’t do surgery, it’s always going to be a little weaker because the two ends of the tendon are separated, and your calf muscle can’t generate as much pressure because your Achilles tendon is effectively linked by them. The physics of it, you can’t generate the pressure on the heel to push off.
The other major advantage to Achilles tendon repair is the lower incidence of it tearing again. You have a significantly higher risk of a repeat Achilles tendon injury if you treat it without surgery. It’s not dramatically higher, but it’s enough for someone who’s active and trying to get back to activities…it’s a better chance that they’re not going to injure it again if you do surgery.
The advice I offer a patient that has an Achilles tendon rupture is know your expectations of what you want to get back to doing. If you’re more of a sedentary lifestyle, this happened because you just missed a step and you’re not active in sports, the conservative treatment is a very reasonable option for you, lower risk of infection or complications from anesthesia. You will get back to doing most of your daily life without surgery. If you’re someone who wants to get back to heavier activities, like sports or your job involves a lot of lifting, carry, ladders and stairs, you may entertain, or really consider, surgical reconstruction where you actually need to have the Achilles tendon repaired to give you a better chance to get back to your previous level of activity.