Though it is the toughest tendon in the human body, the Achilles tendon is widely regarded as one of man’s greatest vulnerabilities. This tendon provides an insurmountable amount of function to our bodies – from stabilizing the lower legs to providing forward thrust for our movements, the human body would be much less functional without the Achilles tendon.
Due to its particular use, position on the human body, and outside stressors, the Achilles tendon is especially susceptible to tear, rupture, and degeneration. These types of injuries may occur slowly over time or may be due to strong, sudden forces.
In either case, surgical intervention may be recommended to repair any outstanding damage to the Achilles tendon. With surgery comes some inherent risks, however.
Anatomy of the Achilles Tendon
The Achilles tendon is a band of tough, fibrous tissue which connects the muscles in the calf to the heel bone of the foot (known as the calcaneus). The Achilles tendon may also be referred to as the calcaneal tendon or heel cord.
The Achilles tendon begins at the calf muscles which is of a group called the posterior superficial compartment. Muscles within this compartment include:
- Plantaris: A tulip-shaped muscle located behind the knee. At its end, a long slender tendon stretches from the mid-calf and becomes a portion of the Achilles tendon.
- Gastrocnemius: One of two major muscles which make up the calf. Separated into two portions – the outer (facing away from the center of the body) and inner (facing towards the inside of the body) heads. Its function within the Achilles tendon is to stabilize the lower leg as well as bend the knee and foot.
- Soleus: Runs from the underside of the knee to the heel. It is involved in standing and walking. The soleus is Heavily reliant on the gastrocnemius and Achilles tendon to provide function.
These muscles converge at about 6 inches above the heel and join into the Achilles tendon which stretches to the back of the heel. By flexing the above-mentioned calf muscles, the Achilles tendon can pull on the heel, allowing us to stand on our toes when running, walking, and jumping.
The Achilles tendon is the largest and what some may consider the strongest tendon in the human body. According to one study, the Achilles tendon can “receive a load stress 3.9 times body weight during walking and 7.7 times body weight when running.”
Despite its strength, the Achilles tendon is one of the most vulnerable parts of the human body. Weak blood supply and high tension make the Achilles tendon especially susceptible to degeneration and rupture.
Diagnosing an Achilles Tendon Tear
An absolute tear of the Achilles tendon will be immediately obvious to the person who just sustained such an injury. Along with instability, a person with a completely ruptured Achilles tendon will lose the complete function of the heel.
Though they may find that they can still wiggle their toes and perhaps have minor movement of the foot, a complete Achilles tendon tear will not allow any movements beyond that.
What is much more difficult to diagnose is the presence of microtears in the Achilles tendon. Over time, these microtears will deepen and worsen and may lead to some of the same symptoms as an absolute tear. This is why it is important to seek a trained medical diagnosis after sustaining any injury to the lower leg, heel, and ankle.
Physical Exam and Medical History
Before any intervention can take place, doctors will perform routine medical exams to guide a more in-depth diagnosis. A patient’s medical history will unveil any past trauma which may be impacting the functionality of the Achilles tendon and can help doctors more accurately pinpoint the current cause of distress.
A physical exam is soon to follow. Your health team will examine your ankle by testing its range of motion. They will apply pressure to extend the ankle past its outer limits and may palpate the area to induce a pain response. They may ask the patient to stand and place all their weight on a single foot.
Any number of physical means can be used to assess the condition of the Achilles tendon, but if these tests are conclusive, they will only lead to one route – medical imaging.
Imaging tests are ordered to confirm the suspicion of an Achilles tendon tear. These tests allow doctors to see the inside structures within the ankle and to observe any oddities or damage which may be causing the patient’s dysfunction. Standard imaging tests include:
- X-ray: While these tests do not show the Achilles tendon, they will be used to identify issues with the bones of the foot and lower leg to determine if another issue such as osteoarthritis is linked to the patient’s pain or dysfunction.
- MRI: By using magnetic fields and image capturing devices, doctors can examine the health of the soft tissues within the ankle with an MRI. While these tests are helpful, they may be a bit unreliable as certain structures within the ankle may resemble an Achilles tear. Using MRIs in addition to other tests listed here will help ensure the Achilles is the issue.
- Ultrasound: These tests use soundwaves to create a map of the soft and hard structures of the ankle. They can help doctors determine if soft tissues are in their proper location or if some may be getting caught in the ankle joint during movement.
With other possibilities eliminated and if conservative treatments failed, surgical intervention is ultimately the last option for treating an Achilles tendon tear. While surgical intervention for an Achilles tendon tear is quite common, many patients come into surgery unprepared for what to expect.
Any patient planning to treat their Achilles tendon tear through surgical means should research every detail heavily before undergoing such an invasive treatment.
Achilles Tendon Tear Surgery Recovery Timeline
Surgery for isolated tears, especially those away from vital organs, is typically minimally invasive. This is true of Achilles tendon tears as well, though recovery times may be particularly long depending on the severity of the tear. Additionally, while certain symptoms may be reduced, due to conditional side-effects, success is highly objective.
Despite these concerns, many patients still opt for surgery as it may be the only treatment option left for their particular issue. Though many factors are out of the hands of the patient, there are certain things they can do to ensure the highest degree of success for their surgery.
Below, are some critical points in the surgical process and details of what to expect. Be sure to talk to your doctor about any concerns you have, and any questions about the surgery.
- Preparing for Achilles Tendon Tear Surgery: Successful surgeries begin with adequate preparation. These preliminary steps help ensure patient safety and may be critical in determining the outcome of the procedure.
- Make sure you understand the type of surgery you are going in for – partial repair, degenerative reconstruction, or complete removal/replacement surgery. Each variety of surgery will require different preparatory steps, procedures, and recovery periods.
- Schedule bloodwork to reduce outside risks such as aversion to anesthetics or uncover any unknown blood or autoimmune disorders.
- Arrange for a ride to and from the hospital. Patients undergoing Achilles tendon tear surgery will be prescribed medications that may prevent them from driving. It is best to have options when going to and from the hospital.
- Prepare a small parcel of luggage for about two- or three days’ worth of trip. Toiletries, entertainment, and clothes may be necessary for the hospital stay.
- Follow your doctor’s orders to a tee. If they give a timeline to refrain from eating or drinking, it is important to follow these guidelines as anesthetics may interfere with the body’s natural digestive processes leading to complications during surgery.
- Maintain an adequate sleep schedule to boost the body’s resilience to post-surgical pain and amplify its healing processes.
- Once all preparatory steps are complete, make sure to check into the hospital on time to ensure doctors have enough time to go through their pre-surgical procedures.
- The Procedure: Achilles tendon tear surgery is typically performed through the aid of minimally invasive tools such as an arthroscope. Surgery may take a couple of hours, after which doctors will monitor the patient’s vital signs to ensure the body responds to surgery well.
- Patients are typically placed under anesthesia until they fall asleep before surgery.
- Doctors will begin the surgery with small incisions in the ankle followed by the insertion of a tiny device known as an arthroscope. The arthroscope creates a small tunnel that burrows through the knee, pushing away surrounding tissues.
- The doctors can place several small tools within the arthroscope to both see what they’re working on as well operate on the tissues directly.
- Depending on the condition of the Achilles Tendon, the doctor will remove small portions of it or the entire thing if its condition is immedicable.
- The doctor will either sew the ruptured Achilles tendon back together, remove degenerated portions of it and sew it back together, or remove it and replace it completely. Understanding your medical diagnosis is critical in determining how long surgery will take, the worse the condition of the Achilles tendon, the longer the surgery will take.
- Once the surgery is finished, doctors will remove the arthroscope and close the incisions.
- First Few Hours After Surgery: Anesthesia will be applied routinely throughout the first few hours after the surgery. Doctors will monitor vital signs to ensure the surgery was successful. Typically, Achilles tendon tear surgery is very low-risk and complications are rare.
- 1-2 Days After Surgery: Recovery for Achilles tear surgery is short. While regular functionality isn’t immediate, patients will be tested for movement within 1-2 days after surgery.
- A physical therapist will be assigned to you and begin a routine of light exercise to help stabilize the ankle.
- Assisted standing and walking may be asked of you during the sessions immediately following surgery.
- In some cases, patients may be asked to perform these light weight-bearing tasks on the same day of their surgery.
- You will be released from hospital care and told to monitor your recovery at home. High fever, excessive bleeding, and escalating pain should be reported to your health care team immediately.
- One Week After Surgery: Patient activity levels will gradually be increased.
- Once the patient is home, they will be asked to follow the routines their physical therapist taught them as well as apply any medication the doctors have prescribed.
- Creams, ointments, and medication should be taken as routinely as the doctors have prescribed and activity levels should be moderate.
- Simple physical therapy such as massage and hot/cold treatments can be applied if medication and rest do not help alleviate post-surgical pain. Consult a doctor if the pain becomes excruciating or if you suffer an ankle injury immediately following replacement surgery.
- After 10 days, the stitches placed to close the wound will be removed and a light-follow up exam will take place.
- One Month After Surgery: Light activities can resume, and physical therapy may intensify.
- At this point, the surgical wounds should be healed and normal activity levels should resume, albeit with minimal pain and discomfort.
- Extended use may cause flare-ups of pain, but these bouts of pain should wane over time as the wounds fully recover.
- One Year After Surgery: By this time the surgical pains should be gone, and normal activity levels should return. While pain and discomfort may be inevitable, these pains should not be so excruciating that they prevent functionality.
- Patients should expect a reduced range of motion as well as reduced weight-bearing capabilities on the leg that was operated on.
- At times, environmental stresses – high elevation, humidity, excess cold/heat – will trigger pain. This is normal and should only be examined if the pain does not subside once environmental factors have been eliminated.
Before applying surgical intervention to any issue, it may be best to consult specialized medical professionals, for even if conservative treatments have been applied there may be other alternatives a patient simply will not know to consider.
One treatment that may help repair light Achilles tendon damage or reduce recovery periods post-surgery is regenerative therapy.
Regenerative Therapy and Achilles Tendon Tears
Regenerative therapy is a rapidly advancing sector of alternative treatments for soft-tissue-related injuries. By harvesting adult tissues directly from a patient, processing them, and then transplanting those processed tissues back into the patient, regenerative therapies help to amplify the body’s healing processes and repair damaged soft tissues in our bodies.
Regenerative therapies come in two major branches – platelet-rich plasma therapy and autologous stem cell procedure – each with its own benefits.
Platelet-Rich Plasma Therapy for Achilles Tendon Tears
PRP injections use a concentrated mixture of one of the body’s natural healing factors (platelets) to amplify its internal healing mechanisms. These tissues are already abundant within the body and are used to repair many of its internal structures.
By harvesting these tissues directly from the patient, isolating them, mixing them with growth factors, and reinjecting them, patients can expect shorter recovery periods as well as better results post-surgery.
Stem Cell Therapy for Achilles Tendon Tears
Autologous stem cell transplants can help provide an environment around injured tissues which helps increase the body’s healing response/cascade The source of the stem cells should be taken directly from the patient’s own healthy tissues.
Mesenchymal stem cell-rich fat (adipose) and bone marrow can be processed in preparation for transplantation to improve the healing process into a pseudo- stem-cell state. These new methods have been developing over the past couple of decades. Tissues can be isolated and mixed with growth factors which help instruct these cells in the repair process.
By transplanting your own stem cells into the site of an injury, the cells can send out chemical signals which attract the new healing cells necessary to repair the damaged tissues, as well as “differentiating” into new tenocytes (tendon cells) to help heal the damaged achilles tendon.
Additionally, combining both of these therapies provides relief from symptoms, boosts the healing processes, and decreases Achilles tendon tear recovery time overall.