What Is the Achilles Tendon, and How Is It Prone to Injury?
The Achilles tendon is present in the lower leg and connects the muscles of the calf to the heel, helping to carry out running and jumping motions. The Achilles tendon can tear or rupture, usually due to a sudden, strong force during tough physical activity. It occurs due to sudden swift movements or by pivoting on the foot. Turning the foot outward too much can increase the risk of a torn Achilles tendon. Ruptured tendons can cause pain and swelling near the heel, and the patient is unable to bend their foot downwards.
The Achilles tendon can also degenerate, and the condition is known as tendinitis or tendinopathy. The symptoms are pain and stiffness along the Achilles tendon on the back of the heel. Overuse and stress on the tendon, especially in cases of increased levels of activity, make the tendon more prone to injury. Short calf muscles are a congenital occurrence that can increase the risk of tendinopathy as the tendon is subjected to greater stress due to such anatomical deformities.
Why Is Achilles Tendon Repair Surgery Needed?
A torn tendon is the primary reason behind surgery. In many cases, a ruptured Achilles tendon may also require surgical intervention. However, other nonsurgical treatments may first be tried in certain cases, including pain medication, a temporary cast, or a brace to prevent undesired movements. Surgery may also be ill-advised in certain medical conditions such as diabetes and neuropathy in the legs.
What Are the Preoperative Preparations Necessary Before Achilles Tendon Repair Surgery?
Before the procedure, certain preoperative measures should be taken. It initiates with a thorough medical history. After recording a proper clinical history and examination, the patient's drug history also has to be noted, as certain medications may need to be stopped before the surgery can be performed. This medication involves Aspirin, and like blood thinning medications, it should be stopped prior to the procedure to avoid the risk of bleeding. If the patient has any habits like smoking, it should be informed to the healthcare provider, and it should be stopped before the surgical procedure. Medical imaging tests are also necessary to identify the extent of the damage.
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X-rays.
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Magnetic resonance imaging (MRI) scans.
It is ill-advised to be eating or drinking the night before the surgery is planned. Recent changes in health, such as a fever or any other conditions, must be reported prior to the procedure. Certain home changes and assistance have to be planned beforehand as the patient will be unable to walk normally for a while. Activities such as driving must also be avoided.
How Is the Surgery Performed?
Achilles tendon surgery can be done by several methods. Usually accomplished by an orthopedic specialist and a group of expert healthcare providers, it is particularly technique sensitive and should be accomplished by an expert professional.
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The patient is put either under general or spinal anesthesia.
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Sedatives are also given to soothe the patient.
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The vitals are monitored continually.
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In the case of a minimally invasive procedure (a surgical procedure done with minimum cuts), the specialist will create smaller cuts.
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The sheath surrounding the tendon is then removed.
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Parts of the damaged tendon are either removed or repaired.
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The Achilles tendon from the other foot may be used as a graft to repair the damaged tendon.
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Any other repairs that are needed are then addressed by the surgeon.
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The doctor will close the skin layer and muscle around the calf with stitches.
What Are the Postoperative Risks Following Surgery?
Achilles tendon repair surgery has certain associated risks, which include the following;
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Excess bleeding at the surgical site.
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Damage to the nerves at the surgical site.
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Infection at the surgical site.
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Blood clot formation and dissemination to other organs.
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Wound healing problems due to preexisting medical conditions.
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Weakness of the calf muscles.
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Complications related to general or spinal anesthesia.
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Persistent pain in the foot and ankle may worsen over time.
Other risks may vary according to the following;
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Age of the patient.
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The shape of the foot.
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Leg muscle size.
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Tendon shape.
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The general health of the patient.
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Type of surgical procedure performed.
What Are the Postoperative Steps Following Surgery?
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The patient is kept in a recovering room, and their vital signs are monitored for a few hours after the procedure. The ankle is kept in a splint to keep the surgical site immobilized. The surgery is usually an outpatient procedure, and the patient is discharged on the same day unless any complications are suspected.
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The patient experiences postoperative pain, especially in the first few days following the procedure. Pain management is done using medication. The leg needs to be kept elevated as often as possible to reduce swelling and pain. If a high fever or increased pain in the ankle or calf is seen, the surgeon's office must be notified immediately. Prosthetic devices such as crutches or walkers are necessary to keep excess weight off the affected foot.
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Suture removal is done around seven to ten days after surgery. The splint may be replaced with a cast at this time, and instructions are given to keep it dry. Orthotics or special shoes may also be given.
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Physical therapy is done by a physiotherapist or an occupational therapist, and strengthening exercises are prescribed to regain the original functionality of the affected area. Putting weight on the affected foot is also subject to the doctor's or the therapist's instructions.
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Achilles tendon surgeries have excellent outcomes unless an underlying disease is present that delays wound healing or any postoperative complications crop up.
Conclusion:
The Achilles tendon repair surgery can be accomplished as minimally invasive surgery. This is accomplished with multiple small incisions rather than a single large one. It may utilize a particular scope with a tiny camera and a light to support the repair. Before the procedure, the patient should be thoroughly educated and instructed about the procedure. Achilles tendon repair surgery is a multiple-team procedure. In the postoperative period patients should be well monitored and should be guided properly by the healthcare provider. Approximately ten days after the surgery, the patient needs to return to the healthcare provider to have the stitches released. The healthcare provider might substitute or replace the splint with a form at that period of time.
