Achilles reconstruction surgery

In patients with persistent inflammatory problem of the achilles tendon and an associated bony spur (insertional tendinopathy).

This may or may not be associated with a bony bump over the heel (Haglund deformity).

Non operative management can be effective in some cases. Surgery is reserved for those patients who have tried other treatments such as modification of shoes, injections, physiotherapy and still have ongoing symptoms.

The surgery to repair this problem is carried out via an incision over the achilles tendon, the tendon is lifted off the bone, any bony spurs are removed and then the tendon is secured back down with a strong repair using bony anchors.

Figure 1: typical skin incision for achilles tendon reconstruction surgery

Figure 2: the achilles tendon is repaired back down to the heel bone with a strong, knotless repair

Success rates: 85-90% of patients are satisfied with their procedure and have good resolution of symptoms

Post-operative plan:

  • Surgery is typically a day case or overnight stay

  • Local anaesthetic is administered to help with pain

  • 0-2 weeks: elevation at home, plaster cast

  • 2-6 weeks: non weight bearing in lightweight removable cast or CAMboot with heel raises

  • 6-10 weeks onwards: CAMboot weight bearing

  • 12 weeks onwards: commence strengthening with physiotherapy

  • Full return to function is typically achieved by 4-5 months post surgery

Download post operative care guide 

Risks of surgery

  • Swelling, stiffness

  • Infection and wound breakdown

  • Blood clots – medication will be prescribed to prevent blood clots post operatively

  • Scar sensitivity

  • Re-rupture – this is high risk in the initial stages, hence the slow rehabilitation protocol.

  • Calf weakness