Achilles tendon rupture
What are Achilles tendon ruptures?
Achilles tendon ruptures are common injuries in the sporting community as well as in the occasional athlete.
What are the symptoms of Achilles tendon ruptures?
A sudden sharp pain in the calf during a sporting activity and hearing a ‘snap/pop’ at the time of the injury is indicative of a muscle or tendon injury. Some patients describe the feeling of being ‘hit with a hard object in the back of the calf’.
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Acute calf weakness, limp and inability to bear weight on the injured leg
- The leg feels weak, even though it is less painful after the tendon has ruptured.
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Pain and swelling in the calf and around the ankle
- The foot and ankle may be swollen after this injury due to bleeding, and because the calf can no longer function as a pump to push venous blood up your leg and towards the heart.
What does Achilles tendon rupture surgery involve?
The latest percutaneous and minimally invasive techniques have fewer complications, especially with wound healing. The minimally invasive suture technique utilises strong suture tape material to grasp the tendon through a very small incision overlying the ruptured tendon.
Tendon ruptures in the higher musculotendinous portion of the tendon may require a minimally invasive incision overlying the tendon and a direct end-to-end tendon repair utilising the same strong suture tape material.
What are the risks associated with Achilles tendon surgery?
Swelling
Swelling of the foot and ankle is common after most ankle surgery. This can be minimised by rest, elevation and the use of a compression sock immediately after surgery.
Infections
Infection after surgery (reduced risk with keyhole and minimally invasive techniques) can be prevented by ensuring that you keep your foot dry, rested and elevated as much as possible in the first three to four weeks after surgery. Feet are closer to the ground and tend to swell more than other areas of the body, putting additional stress on healing wounds. Feet and shoes are colonised with bacteria that can flourish in wet conditions and around fresh bleeding wounds.
Risk of tendon re-rupture
The risk of re-rupture following surgical repair is in the order of 2-5% and for non-operative management, around 5-10%.
These numbers vary through the literature. Surgery ensures that there is a smaller gap between tendon ends and reduced scarring at the site of tendon rupture. Once the muscle strength is restored through rehabilitation, the chances of a permanent limp are also reduced.
Deep Vein Thrombosis (DVT’s)
You will be prescribed a dose of Aspirin to be taken for two to three months following surgery. The presence of certain risk factors may necessitate blood-thinning injections for a period after surgery. Drinking plenty of fluids and performing frequent ROM exercises may prevent DVTs.
Joint stiffness
Initial ankle stiffness that improves with exercises.
Scarring around surgical wounds
Unlike other areas of the body (face, hands), we advise patients to avoid manipulating or massaging a scar until it is well healed (usually around five to six weeks following foot and ankle surgery).
Achilles Tendon Repair surgery aftercare/rehabilitation
General post-operative and wound care instructions will be emailed to you before your surgery. These documents also contain the date and time of your first appointment after surgery.
Dressings
Your foot and ankle will be heavily bandaged after surgery. These bandages are necessary to prevent bleeding after surgery. It is advisable to keep the foot dry, rested and elevated in the first three to four weeks after surgery. This requires you to seal the area when taking quick showers. Frequent change of dressings and getting your dressings wet and dirty may predispose you to an infection. We strongly discourage dressing changes at home.
A wound care document is emailed to you along with all your preoperative paperwork.
Post-operative wound care is our priority. Following our instructions will ensure that all your wounds heal well. You are encouraged to call or email us to ask for advice or to discuss any concerns around wound care.
Boots, mobility aids and physiotherapy
A back slab is applied in the operating theatre after surgery is completed. The back slab is replaced with a boot and three heel wedges at the first follow-up appointment.
Mobility aids like crutches, frames and knee scooters will be provided by the hospital physiotherapist. Feel free to take your own mobility aids with you when you present to the hospital. The physiotherapist will make sure that you are using them correctly.
It is essential to leave the boot on in bed for the first four to six weeks or to purchase an adjustable night splint to hold your foot in position when you are resting. It is essential to use the boot when walking, especially at home. You can put full weight on your foot and are not required to bear weight through your heel.
Early gentle ROM exercises and rehabilitation are encouraged in order to get the best outcome following surgery. You may continue upper body and abdominal strengthening as well as straight leg raising (SLR) exercises while recovering from your surgery.
Formal physiotherapy sessions to regain balance and strength may commence when you are able to bear full weight on your foot.
What should I expect when recovering from Achilles Repair (minimally invasive technique)?
Achilles repair (minimally invasive technique)
Week 2-6: Weight Bearing as tolerated in boot, gentle active Range of Motion exercises (ROM). Progressive plantar flexion (toes pointing down). Two to three heel wedges in the boot.
Week 6-8: Walking and cycling (in boot or 90-degree splint) but care to avoid forced dorsiflexion (toes pointing up – this position should be avoided). Two heel wedges in the boot/ shoe.
Week 9-10: Weight Bearing rehabilitation may commence under the guidance of a physiotherapist. One heel wedge in the boot.
Week 10-12: Walking in the boot (no wedges). Commence transitioning out of boot and cautious progressive calf strengthening under the guidance of a physiotherapist.
Rest and elevation
Feet and ankles are more likely to swell after surgery. Swelling can cause a lot of pain and discomfort, requiring the use of excessive pain-relieving medication. The most reliable way of reducing immediate post-operative swelling is to keep your foot elevated above the level of the heart. Reducing physical activity can help control swelling and pain, especially in the first three to four weeks after surgery.
Blood-thinning medication to prevent Deep Vein Thrombosis (DVTs)
You will be prescribed a dose of Aspirin to be taken for two to three months following surgery. The presence of certain risk factors may necessitate blood-thinning injections for a period after surgery. Drinking plenty of fluids and performing frequent ROM exercises may prevent DVTs.
Pain medication
Our anaesthetists will provide you with adequate pain-relieving medication to take home after your surgery. The anaesthetist may also discuss having a nerve block for pain relief just before surgery. The most reliable way to reduce pain and swelling after surgery is to rest and elevate your foot as much as possible.
Prevention of infections
Intravenous antibiotics are administered at the start of every operation, and the foot is thoroughly cleaned. You will be given a script for antibiotics upon your discharge from the hospital. Rest and elevation, using your postoperative moon boot and leaving all dressings dry, can help prevent postoperative infections.
Driving
Driving is unsafe for as long as you are required to wear your postoperative moon boot, as advised by us during the course of follow-up appointments after surgery.
Holidays and long-distance travel after surgery
It is advisable to avoid surgery if you have a planned holiday or long-distance travel plans within weeks after surgery. Please discuss these plans with us so that we can advise you on the most appropriate time to have surgery.
Return to sport
This is determined by your physiotherapist and guided by us. Cycling and walking on a treadmill may commence at three to four months. You may jog at four to six months following surgery. Sport-specific training may commence gradually at four to six months after surgery. Progressive return to light sport/low-impact activities may begin after six months. Return to high-impact activities, e.g. soccer, football, may be considered after nine to twelve months after surgery.
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Why choose SA Foot & Ankle Surgery?
Quick bookings at multiple locations
With multiple clinic locations across Adelaide, we offer immediate availability, often seeing patients within 24 hours of receiving a referral.
Advanced care for your condition
Our specialised procedures, including advanced surgeries like ankle fusions, prioritise quicker recovery and less discomfort.
Foot and ankle specialist surgeon
Unlike general practices, we specialise exclusively in foot and ankle conditions, ensuring you receive expert care tailored to your specific needs.
Tailored treatment plans
We thoroughly assess your needs and present personalised treatment options, including non-surgical solutions where appropriate.
Patient-centred care
We take the time to explain your condition and treatment options, ensuring you’re fully involved in every decision regarding your health.
Low gap (total out-of-pocket cost) *
For most operations, your gap paid to the practice is the only out of pocket cost for surgery, without additional or hidden costs. There is a separate gap payable to the anaesthetist and the surgical assistant who work alongside, but independently of Dr. Silveira.
* Complex procedures may attract additional costs that will be discussed with you at the initial consultation.
Meet Dr Gayle Silveira, the surgeon behind your care
Gayle Silveira is a fellowship-trained foot, ankle and trauma surgeon. She completed Orthopaedic training in Adelaide and is a Fellow of the Royal Australasian College of Surgeons.
Gayle gained further experience in complex surgical techniques through advanced training in foot and ankle surgery under the guidance of Dr. Simon Platt. She is proficient in keyhole surgery/minimally invasive techniques and management of sports injuries. In addition, her Master’s in Biomechanics and Sports Physiology complements her expertise in foot and ankle pathology.
Gayle is committed to offering her patients high-quality care with compassion and respect. She spends time listening to you whilst carefully formulating a tailored management plan. Her goal is to help you achieve your desired outcome.
Fellow of the Royal Australasian College of Surgeons (Orthopaedics)
Member of the Australian Foot and Ankle Society
Bachelor of Medicine and Surgery
Master's Sports Studies (Biomechanics and Sports Physiology)
Member of the American Foot and Ankle Society
