What is Achilles Tendonitis?
First, here is a quick refresher on what we are dealing with. Achilles Tendonitis happens when your Achilles tendon becomes irritated and inflamed. This can be due to overuse, sudden increases in activity, or even just aging. An Achilles tendon injury, like a tear or a full-on rupture, can happen from direct hits, cuts, or heavy force, like when you jump. It can also come from lots of minor stresses over a long time. Usually, these little stresses do not get treated, making the tendon weak. Eventually, the tendon cannot handle sudden stress from your ankle or knee, leading to a partial or complete tear. This usually causes pain at the back of your ankle, making walking, running, or even standing up from a chair incredibly uncomfortable.
Why Surgery?
When conservative treatments—like Platelet Rich Plasma Injection, Remy Laser Therapy, anti-inflammatory medications, and physical therapy—do not help, surgery may be the next step. This is especially true if the tendon has developed chronic damage or tiny tears will not heal. Surgical options like tendon debridement and repair with a graft aim to clean up the damaged area and provide extra support for healing.
Tendon Debridement
Tendon debridement is a medical term for cleaning up the damaged parts of the tendon. During this procedure, the surgeon makes a small incision in the back of your ankle to access the Achilles tendon. Debridement gets rid of the messed-up tissue in the Achilles tendon and stitches the good parts back together. This process helps ease the pain from the constant inflammation of the damaged bits.
If not enough healthy tendon is left to work on its own, the surgery will be reinforced with a graft so it can function better.
Repairing Achilles Tendonitis with Graft Jacket
Sometimes, just cleaning up the tendon is not enough. If a significant portion of the tendon is damaged, it might need some extra support. This is where the graft jacket comes in. The graft is a special material made from donated human tissue or synthetic materials. It is designed to provide a scaffold for your own cells to grow into, effectively reinforcing the tendon.
After removing the damaged tissue, the surgeon wraps the graft jacket around the tendon. Over time, your body integrates this graft into the natural tissue, strengthening the tendon overall.
Cast Support
After surgery, your foot and ankle will likely be put in a cast. This cast is essential because it limits motion, giving the tendon a chance to heal without any extra stress or movement that could mess up the repair. The time you will need to wear the cast can vary, but it is usually around six to eight weeks.
During this casting period, it is crucial to keep weight off your foot as much as possible. This means you will likely need to use crutches or a knee scooter to get around. Following your surgeon’s instructions closely is important as they may give you specific guidelines on how to care for the cast, things to watch out for (like signs of infection), and any other precautions to ensure your tendon heals properly.
Your surgeon may set a timeline for follow-up appointments to check on your progress. During these visits, we will monitor the healing, make any necessary adjustments to your treatment plan, and eventually remove the cast. Once the cast is off, you will likely start physical therapy to help regain strength and flexibility in your ankle and foot, which is a crucial part of the recovery process.
What to Expect
For the latter reason, surgery is often needed to avoid severe symptoms and restore functionality in repairing a torn Achilles tendon. Most often, procedures are debridement and tendon graft. Although surgery is a big operation, it can often lead to significant or complete pain relief and enhanced mobility; this includes:
- 0-6 weeks recovery: During immobilization for the first six weeks, often with a cast or boot, to protect the repaired tendon. Pain control and elevation are both critical.
- Physical therapy: After the initial healing phase has passed, physical therapy is vital to rebuild strength, flexibility and range of motion. This can be anything from exercises to stretching and strengthening programs.
- Gradual return to activity: You will reintroduce physical activity slowly with guidance from your podiatrist.
Final Thoughts
Achilles tendonitis can be a real bummer, but modern surgical techniques tailored to your specific needs offer a promising solution. These procedures aim to clean up damaged tissue and provide extra support for a more vital, healthier tendon. While the road to recovery might be long and challenging, many find that the end result is worth the effort. If you are struggling with chronic Achilles tendonitis and conservative treatment is not cutting it, it may be time to chat with your doctor about surgical options. Who knows? It could be the first step toward getting back on your feet—literally.
