Achilles Tendon Repair: A Surgeon’s Inside Look at the Procedure That’s Changing Lives

If you’ve ever suffered an Achilles tendon injury, you know how debilitating it can be. You may be unable to walk, run, or even stand without pain. Achilles tendon repair surgery may be your best option. This procedure can be done via traditional open surgery or minimally invasive techniques. There’s also a specific approach for neglected injuries that have worsened over time.

After surgery, physical therapy and rehabilitation are crucial to regain strength and mobility. However, as with any surgery, there are potential risks and complications you should be aware of.

In this article, we’ll delve into the details of Achilles tendon repair, so you’re well-informed about the procedure. Whether you’re considering surgery or simply want to understand more about this common injury, keep reading to learn more about the process, the recovery, and what you can expect.

Understanding Achilles tendon repair surgery

You might be wondering, ‘what’s this Achilles tendon repair all about?’ Well, let’s dive into it together and unravel the mystery!

Your Achilles tendon is the largest tendon in your body, connecting your calf muscles to your heel bone. It’s what allows you to push off your foot and walk, run, or jump. But what happens when it ruptures? That’s when you might need an Achilles tendon repair.

Now, don’t panic! This procedure is designed to reconnect and heal your traumatized tendon. It’s usually recommended for those who’ve completely torn their Achilles tendon, especially in a younger, athletic patient.  Although there can be some injuries treated with a nonsurgical/conservative approach, it is important to be assessed by a well-trained provider to determine whether the patient would be a candidate for conservative management in the first place.

Some of the benefits of a surgical approach for Achilles tendon repair would be more aggressive rehabilitation, restoring the appropriate tension in the tendon and likely return back to baseline athletics sooner.

Here’s what you can expect during the procedure. You’ll be given anesthesia to numb the pain. Your surgeon will then make an incision in your calf to access the damaged tendon. They’ll sew the torn ends together and, if necessary, use a graft to reinforce the repair. This graft could be a piece of another tendon or synthetic material. Once everything’s back in place, the incision is closed and your recovery begins.

Post-surgery, you’ll likely be in a cast or walking boot to keep your tendon immobile while it heals. Physical therapy will also be a vital part of your recovery to regain strength and flexibility in your leg.

So, that’s the basic rundown of Achilles tendon repair. It’s a procedure that’s all about healing and recovery, helping you get back on your feet and doing the things you love. Remember, it’s important to follow your doctor’s guidance every step of the way to ensure a successful recovery.

Minimally Invasive Achilles Tendon Repair

For the majority of acute ruptures of the Achilles tendon, Dr. Nodelman at District Foot and Ankle will utilize a minimally invasive approach to repair of the two ends.  With a minimally invasive approach, there is a smaller incision which can reduce the risk for wound healing issues and infection as well.

During this procedure, you’ll be under anesthesia, and your surgeon will make a small incision, typically just a few centimeters long, on the back of your ankle. Through this incision, a jig is inserted to surround the tendon through which multiple sutures are inserted.  The jig was then removed from the surgical wound and the effect of this is to bring the sutures into the wound.  The same process is performed for the other side of the rupture and ultimately the sutures are tied together to bring that to ruptured stumps together.

This technique works well for acute ruptures but is typically not performed for chronic/neglected ruptures.

After the surgery, you’ll likely need to wear a boot or cast to protect and support your mended tendon. Physical therapy will also be a crucial part of your recovery to regain strength and flexibility.

Remember, while minimally invasive Achilles tendon repair has its advantages, it’s not suitable for everyone. You and your doctor should thoroughly discuss your options and consider factors such as your overall health, the severity of your injury, and your recovery goals. This will ensure you choose the best treatment plan for your unique situation.

Neglected Achilles Tendon Repair

When it’s been a while since the injury occurred, addressing the damage can present a whole new set of challenges. This is especially true when dealing with a neglected Achilles tendon rupture. For one, the tendon may have significantly shortened due to the delay in treatment, and there may also be a considerable gap where the tendon has retracted in addition to a significant amount of scar tissue.

But don’t worry, even if your Achilles tendon injury has been neglected, there are still options to repair it.

One of the first steps in treating a neglected Achilles tendon injury is diagnosis. Your doctor will assess the extent of the damage and the length of time since the injury occurred. They’ll use a combination of physical examination, medical history, and imaging tests like MRI or ultrasound. This will help them determine the most suitable treatment plan for you.

One common method for repairing a neglected Achilles tendon is through surgical intervention.  Typically, healthier tendon tissue needs to be transplanted to reconstruct the chronically ruptured and scarred tendon.  Additionally, a tendon transfer may need to be performed as well.  The most common tendon transfer performed for a neglected rupture would be a flexor hallucis longus transfer.  This is the tendon that typically will plantarflex the big toe.  It is released at the level of the ankle joint and then transplanted and secured into the heel bone.  As such, the tendon becomes a plantar flexor of the ankle instead of plantarflexing the big toe.

Remember, even if your Achilles tendon injury has been neglected, it’s never too late to seek treatment. With the right care and rehabilitation, you can get back on your feet and return to your normal activities. It may be a more complex process, but with patience and determination, you can successfully recover from a neglected Achilles tendon injury.

Physical Therapy and Rehabilitation

It’s in the realm of physical therapy and rehabilitation where the real magic happens, as this is where the journey towards regaining strength, flexibility, and balance begins.

After an Achilles tendon repair surgery, your doctor will likely recommend you start a physical therapy program. This is a vital step in your recovery process, as it helps to improve the function of your newly repaired tendon.

Initially, your therapy may involve gentle range-of-motion exercises. These help to reduce stiffness and increase your ability to move your ankle and foot. You’ll also learn exercises to strengthen your calf muscle, which can help support your recovering tendon. It’s important to remember that everyone’s recovery is unique, so it’s crucial to listen to your body and not push yourself too hard.

As your strength and flexibility improve, your therapist may introduce more challenging exercises. These might include balance exercises or functional exercises, designed to help you return to your usual activities. You’ll also be shown how to properly stretch your Achilles tendon, which can help prevent future injuries.

Physical therapy and rehabilitation don’t just focus on your physical recovery. Therapists also provide emotional support and guidance. They’re there to motivate you, answer your questions, and help you navigate the ups and downs of recovery.

Remember, it’s not a race to the finish line. Take things at your own pace and celebrate your progress, no matter how small. It’s all part of your journey towards getting back on your feet and returning to your normal activities. Don’t rush the process. Your body needs time to heal and adapt to the changes. With patience and consistent effort, you’ll see improvement over time.

Potential Risks and Complications

While the road to recovery may seem straightforward, there’s no denying that there are potential risks and complications that can arise. Just like any other surgical procedure, Achilles tendon repair comes with its own set of potential issues. It’s crucial for you to be aware of these, so you can make an informed decision about your treatment.

One common risk is infection. Despite all the precautions taken, there’s always a chance that the surgical site might get infected. You’ll need to monitor the area closely for signs of redness, swelling, or discharge.

Another risk is nerve damage. While rare, it’s possible for the nerves near the Achilles tendon to be accidentally injured during surgery.

Blood clots are another potential complication. These can form in the leg veins after surgery, causing pain and swelling. In some cases, they can travel to the lungs and become life-threatening. You might be prescribed blood thinners to help prevent this.

There’s also a chance of re-rupture. This means the repaired tendon tears again, which can happen if you put too much stress on it too soon after surgery. It’s important to follow your doctor’s advice about when and how to start using your foot again.

Every surgery carries risks, but remember that complications are not the norm. Most people recover from Achilles tendon repair without significant issues. The key is to be aware of the potential risks, take steps to prevent them, and work closely with your medical team. You’re not just a patient – you’re a crucial part of your own recovery process.


In conclusion, you’ve explored the world of Achilles tendon repair. You’ve seen how the minimally invasive procedure works, and even delved into neglected repairs.

You’ve learned about the importance of physical therapy and rehabilitation, and weighed potential risks and complications.

Now, you’re better prepared to make informed decisions about your health. Remember, it’s your journey to recovery, so take it step by step.