Surgery to the Achilles tendon may involve a tendon repair or a tenotomy procedure.
Achilles Tendon Anatomy
Tendons are the soft tissues connecting muscle to bone. The Achilles tendon is the longest tendon in the body and is present behind the ankle, joining the calf muscles with the heel bone. Contraction of the calf muscles tightens the Achilles tendon and pulls the heel, enabling the foot and toe movements necessary for walking, running and jumping.
Achilles Tendon Injury
The Achilles tendon is often injured during sports activities, resulting in an inflammatory condition called tendonitis, which is characterized by swelling and pain. In some cases, severe injury results in a tear or rupture of the Achilles tendon, requiring immediate medical attention.
Causes of Achilles Tendon Injury
The tear or rupture of the Achilles tendon is commonly seen in middle aged men who involve in sports activities. The tendon ruptures due to weakness as a result of advanced age or from sudden bursts of activity during sports such as tennis, badminton and basketball. Having a history of tendonitis, certain diseases such as arthritis and diabetes, or certain antibiotics can make you more susceptible for ruptures.
Symptoms of Achilles Tendon Injury
The classic symptom of an Achilles tendon rupture is the inability to rise up on your toes. You may often experience a “popping” or “snapping” sound with severe pain, swelling and stiffness in the ankle region, followed by bruising of the area. If the tendon is partially torn and not ruptured, pain and swelling may be mild.
Diagnosis of Achilles Tendon Injury
The diagnosis of a torn or ruptured Achilles tendon starts with a physical examination of the affected area, followed by a Thompson test in which the calf muscle is pressed with you lying on your stomach to check whether the tendon is still connected to the heel or not. In certain cases, an ultrasound or MRI scan may be needed for a clear diagnosis.
Treatment of Achilles Tendon Injury
The main objective of treatment is to restore the normal physiology of the Achilles tendon so you can perform your normal activities.
Immediately following a torn or ruptured Achilles tendon you should employ the R.I.C.E. method as follows:
- Rest the injured part.
- Ice packs should be applied at the site of injury to prevent swelling.
- Compress the injured area to prevent swelling.
- Elevate the injured part to reduce swelling.
Procedure for Achilles Tendon Repair
Surgery may be recommended especially for competitive athletes, those who perform physical work, or in instances where the tendon re-ruptures. Your surgeon will stitch the torn tendon back together with strong sutures. Your surgeon may reinforce the Achilles tendon with other tendons depending on the extent of the tear. If the tendon has avulsed or pulled off the heel bone, your surgeon will reattach the tendon to the heel bone.
Complications of Achilles Tendon Repair
As with all surgical procedures, Achilles tendon repair may be associated with certain complications such as infection, bleeding, nerve injury and blood clots.
What is an Ankle Tenotomy?
Ankle tenotomy is a surgical procedure to lengthen the Achilles tendon enabling the ankle to flex upward and allowing the heel to be placed flat on the floor. It is indicated in patients that have an abnormally developed Achilles tendon or one that has become shortened and difficult to stretch. The surgery is done to restore the normal range of motion of the ankle.
What are the Indications for an Ankle Tenotomy?
It is commonly indicated in the treatment of the below conditions when conservative measures such as physical therapy and splinting have failed:
- Clubfoot: A developmental disorder where the child is born with one or more abnormally short ankle muscles which turn the feet inward. Ankle tenotomy is usually performed after the Ponseti method to treat clubfoot.
- Contractures: Muscles become stiff after a period of immobilization
How is an Ankle Tenotomy Procedure Performed?
Ankle tenotomy is performed under local anesthesia. A knife is inserted into the skin at the region of the tendon and cuts are made. As the cut edges draw apart, the tendon lengthens and heals in this position. For more severe cases, your child’s doctor may expose the tendon through an incision under general anesthesia and cut the tendon, which is then joined by sutures to form a lengthened tendon. Casts are then applied with the tendon in the correct anatomic (stretched) position. After two to three weeks, your child’s doctor will remove the cast and order physical therapy to improve ankle strength and keep the tendon stretched.
What are the Complications of Ankle Tenotomy?
As with all surgical procedures, ankle tenotomy may be associated with certain complications such as nerve and blood vessel damage, infection, over-lengthening of the tendon or shortening of the tendon as your child grows which may require a second surgery.