Achillies tendon aug 2017

Podiatric Surgery

Achilles Tendon Surgery Introduction

This leaflet will explain what will happen when you come to the hospital for Achilles tendon surgery.

Why do I need this surgery?

Surgery to lengthen the Achilles tendon is normally recommended where the calf muscles have become too tight, putting too much tension on the foot. This is usually part of surgery to correct a flat foot deformity. Surgery is also recommended when you have damaged the tendon, either by tearing or because the tendon itself has become scarred by chronic irritation. The individual circumstances will have been discussed with you prior to surgery.

What does surgery involve?

On the day of surgery you will be admitted to the ward and one of the nursing staff will check you in, take your blood pressure and perform any other tests that may be required. Your surgeon will remind you of the surgical process and possible complications and will ask you to sign a consent form.

At some point during the morning/afternoon you will be escorted to theatre. The operation will be performed under local anaesthetic: you will be awake but the foot will be numbed via a series of injections either around the ankle or an injection in the back of your knee, which most patients find comfortable. You can therefore have a light snack before the procedure. This type of anaesthetic can take 24-36 hours to wear off, during which time you will also lose the ability to move your leg voluntarily. This provides a considerable advantage in that you need far fewer painkillers.

Once your anaesthetic has been achieved, you will still be able to go to the bathroom but you must ask the nursing staff for assistance. The effects of the anaesthetic can come on surprisingly quickly and you could easily fall over.

Day vice

The operation takes about 60 minutes, after which you will be placed into a leg cast: initially plaster of Paris, and a few weeks later into an acrylic cast. This will allow the tendon to heal.

After the operation you will be taken back to the ward and given a drink and something to eat. You will be advised on pain killers and once ready, you will be discharged from the day surgery unit. You will be given a post-operative boot.

You must be driven home and have a carer for 48 hours.

You will be advised of your follow-up appointment date, either on the day or by letter in the post.

How will I feel afterwards?

Although long-acting local anaesthetic administered during the procedure should control most of the pain for about eight to 10 hours, you can expect some pain or discomfort after the operation. Painkillers will be discussed with you prior to your operation and you should bring these with you on the day of surgery.

1 PFS-2390-1730-01

Achilles Tendon Surgery Recovering from surgery The first two days You will not be able to weight-bear after the operation but you will be provided with crutches to help you get about.

You will need to rest up as much as possible with you leg elevated. You should limit activity to going to the bathroom only. Continue taking your painkilling tablets.

Two to seven days After two days, you should get up and aim to move about for 20 minutes within the hour, resting with the leg elevated at all other times. Do not put any weight on your casted leg and keep it dry.

At seven days The cast may be removed and the wound checked. Another cast will be applied. Continue to not put any weight on your casted leg and ensure it remains dry.

At 14 days The stitches are usually removed and a lightweight cast will be applied. If all is well you will stay in this cast for six weeks. Do not put any weight on your casted leg and keep it dry.

At six weeks A further cast may be required, or you may be given a special boot to wear. Gentle weight-bearing may begin. There will be some loss of muscle bulk and the skin will be dry. Apply moisturiser to improve the skin condition. An ice pack can be applied to your foot to ease any remaining swelling. You will be advised accordingly.

At 12 weeks Your foot will continue to ache when walking and will still be swollen. Continue to regularly use ice packs. When you start to walk more normally you should wear trainers only for the next few months. Gradually you will recover strength, flexibility and mobility. You should be getting back to normal activity by about four months, but the foot will continue to improve over a 12 month period.

What are the possible risks and complications?

No surgery can guarantee to be successful but the vast majority of people are satisfied with the outcome of their surgery. This information tells you about the more common complications relating to foot surgery in general and more specifically to this type of operation.

Day vice

General complications of foot surgery Pain: There will be post-operative pain. For most people the pain passes after 24-48 hours and is tolerable with regular painkillers (following dosage recommendations).

Swelling: This is a normal outcome of any operation. The extent of post-operative swelling varies and cannot be predicted. In some people the swelling reduces within a matter of weeks and in others could take many months. Application of an ice pack greatly reduces the swelling.

Infection: There is a small risk of infection with all surgery. This would be treated with relevant antibiotics.

Look out for redness and discharge from the wound.

Deep vein thrombosis (DVT): Also known as venous thromboembolism (VTE), this is a rare complication of foot surgery under local anaesthetic. The risk increases if you are having a general anaesthetic. There is also an increased risk if you smoke, take the contraceptive pill or HRT. Immobilising the leg in a cast also increases the risk of a DVT. If you have had a DVT in the past, please tell your surgeon. If you do have certain risk factors you will have an injection to thin your blood on the day of surgery. This might need to be repeated for up to seven days following surgery.

2 PFS-2390-1730-01

Achilles Tendon Surgery Complex regional pain syndrome (CRPS): This is a rare but difficult complication. It is an abnormal response of the nervous system to surgery but can happen after simple trauma. This can lead to a variety of painful sensations in the foot, which require medical and pain relieving techniques.

Scarring: As a result of your surgery you will have a scar on your foot. To begin with the scar will be raised, red and sensitive but with time it will usually settle.

Specific complications of Achilles tendon surgery The tight muscles can recur. This may take years to occur and is not necessarily a problem.

Lengthening a tendon may increase the stress placed across other joints of your foot and can increase the onset of arthritic changes in other joints of your foot, especially if there is already arthritis present.

Prolonged swelling can occur but can be helped by ice applications.

Weight-bearing can move to the other areas of the foot after the operation causing pain.

The incision is close to a large nerve on the outside of the ankle and sometimes damage to the nerve can happen. This could cause permanent numbness on the outer edge of the foot and can be painful. However, this is rare.

The tendon could rupture again.

This leaflet is intended as a guide only. The vast majority of patients who have Achilles tendon surgery have very good results. Occasionally, complications occur which alter the normal post-operative recovery outlined in this leaflet. These will be identified and discussed at your follow up appointments.

Useful numbers Braintree Community Hospital

Podiatric Day Surgery Unit

01376 555 900

01376 555 908

If you have any concerns during the first 24 hours following your discharge from hospital, please telephone the ward you were on. After 24 hours, please seek advice from your GP.

Day vice

This document can be made available in other languages and formats upon request.

Podiatric Surgery at Braintree Community Hospital, April 2015. Review due: July 2019

3 PFS-2390-1730-01