Insertional Achilles Tendinopathy Surgery

The Surgery

• The surgery involves an incision over the achilles insertion and detachment of the insertion from the bone
• The bone spur, bursa and degenerative tendon are removed
• The tendon is then sutured back using bone anchors
• Sometimes a tendon transfer is performed to improve strength and blood supply to the repair

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The Hospital Stay

• You wake up with bulky bandages a boot with 3 wedges inside
  
• You will stay in hospital overnight, with your foot elevated and you have will have antibiotics through a drip
• Depending on your medical conditions, you will either need aspirin or clexane injections to thin your blood for 6 weeks
• You will be only allowed to touch your foot to the ground for 2-3 weeks
• Depending on your balance and strength, you may need rehabilitation post operatively
• Buying a second hand knee scooter pre operatively (can search online) and practicing at home before the surgery, can be helpful; please bring it into the hospital with you. It is easier to use a knee scooter than crutches

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When You Go Home

• You will need medications for pain relief
• You will need either aspirin or clexane for 6 weeks to prevent blood clots
• Please leave all dressings intact until your appointment with Dr Graff
• You will get an appointment for your post op appointment in 2-3 weeks where the dressings will be taken down
• After this you will be able to shower normally and pat the dressings dry

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Rehabilitation

*All patients are different. These timelines are only a guide, and some patients may progress faster or slower than others.

• You will need a boot with 3-4 wedges for 4 weeks
• You will have appointments with Dr Graff at 2 weeks and 6 weeks

0 - 2 Weeks

• You will be in a boot with 3-4 wedges
• ‍You will only be allowed to touch your foot to the ground for balance. You will need to bag the leg for showers
• ‍Pain relief: Please take regular paracetamol with meals and before bed; you may need stronger pain killers as well, especially before bed Please take aspirin 150mg daily or clexane for 6 weeks

2 - 4 Weeks

• Post op appointment with Dr Graff
• You will then go back into the boot with 3 wedges to wear at all times except for showering
• You can start partial weightbearing in the boot (20-50% body weight)
• You can take the boot off for showers only to sit on a shower chair and keep the foot pointed down
• You can start physio for isometric calf strengthening and hip and knee strengthening and leg lifts with the boot on

4 - 6 Weeks

• You can remove 1 wedge per week of the boot
  
• You can increase to full weightbearing in the boot
• You can start active theraband inversion and eversion exercises below neutral with physio

6 - 8 Weeks

• ‍Post op appointment with Dr Graff You can weightbear as tolerated in the boot without wedges
• Physio for active plantarflexion and dorsiflexion to neutral (pain free) and continue resisted inversion/eversion with foot in neutral and propropception training

9 - 12 Weeks

• You can wear normal shoes if you are able to fit into them (may still have swelling)
  
• You can range the ankle past neutral with physio

3 - 6 Months

• Post op appointment with Dr Graff You can progress strengthening and range of motion with pain free double leg heel raises with physio From 4 months, light jogging can commence if there is no pain
• You can walk bare footed

6 - 12 Months

• When the leg feels back to normal and the same as the other leg, you can start sport specific training and heavy labour work

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When can I return to work/school?

• Seated work 4-6 weeks
• Prolonged standing 10-12 weeks
• Heavy labour work 9-12 months

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When can I return to sport?

• Start sport specific training at 6-8 months
• Return to sport when leg same as the other side (9-12 months)

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When can I drive?

• Left foot 6-8 weeks
• Right foot 10-12 weeks

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What can go wrong?

• Anaesthetic problems
• Nerve injury
• Blood clots
• Infection
• Stiffness Rupture
• Ongoing pain
• Further surgery

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If you want more information, or have any questions or problems, please contact Dr Graff on admin@christygraff.com or please call the rooms on 0493 461 133.