Achilles tendonitis
What is Achilles tendonitis?
Pain around the Achilles tendon at the back of the heel is not an uncommon problem in both men and women. It occurs at an earlier age in men and usually in women in their 60s. It may occur at the insertion of the tendon at the heel or higher up in the calf, where the tendon meets the muscle.
X-rays may show a Haglund deformity (pump bump) or a large spur around the insertion of the tendon in the heel. The spur itself is not the main problem, as is often believed. A degenerative and inflamed Achilles tendon causes swelling and pain at the back of the heel.
What are the symptoms of Achilles tendonitis?
If you notice these symptoms, consulting a specialist can help address the condition and prevent it from worsening.
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Pain, swelling and redness at the back of the heel
- The Achilles tendon is inflamed and thickened, and may rub on the back of the shoe.
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Cramping in the calf muscles
- The calf may sometimes feel tight, and you may suffer from cramping pain.
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Associated plantar fascitis
- Plantar heel pain may sometimes be associated with Achilles tendon pathology.
What does Achilles tendonitis surgery involve?
Surgery is offered to patients with insertional Achilles Tendonitis that has failed to resolve with non-operative management. An incision is made on the back of the heel down to the tendon. The tendon is debrided, and bony prominences are shaved down to decompress the region. The tendon is then reinserted into the heel with the help of strong suture tape and bioabsorbable screws. This procedure may be combined with a keyhole calf lengthening procedure for better results.
What are the risks associated with Achilles tendonitis 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. Feet and shoes are colonised with bacteria that can flourish in wet conditions and around fresh bleeding wounds.
Recurrence of symptoms
Recurrence of symptoms due to many factors, but it largely depends on the severity of tendon pathology, duration of symptoms and coexisting ankle and foot pathology. The Achilles tendon may remain thickened for up to a year after surgery. Regular stretching programs incorporated into the daily exercise regimen can keep symptoms at bay.
Deep Vein Thrombosis (DVTs)
Deep Vein Thrombosis may occur when you have certain risk factors and are unable to bear weight on your leg for a prolonged period. We will prescribe blood-thinning medication to prevent DVTs from forming. Drinking plenty of fluids and frequent range of motion (ROM) exercises may prevent DVTs.
Joint stiffness
It is not unusual to have ankle stiffness that improves with time and regular exercises.
Calf weakness and a limp
The calf may remain weak, resulting in a limp in your gait. Regular calf strengthening exercises should be carried out for at least a year following surgery.
Scarring around surgical wounds
Achilles foot wounds can take longer to heal and can sometimes scar poorly. Unlike other areas of the body (face, hands), we advise patients to avoid manipulating or massaging a foot scar until it is well healed (usually around five to six weeks following foot and ankle surgery).
Achilles tendonitis 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.
Shoes, boots and mobile aids
A back slab is applied in the operating theatre after surgery is completed. The back slab is replaced with a boot one to two 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 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.
What should I expect when recovering from Achilles Tendonitis Surgery (minimally invasive technique)?
Achilles repair (minimally invasive technique)
Week 2-6: Weight Bearing as tolerated in boot, gentle active Range of Motion exercises (ROM). One to two heel wedges in the boot.
Week 6-8: Walking and cycling (in boot or 90-degree splint). Single heel wedge in the boot.
Week 9-10: Weight Bearing rehabilitation. No wedges in the boot.
Week 10-12: Commence transitioning out of boot and cautious progressive calf strengthening.
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 post-operative shoe or boot and leaving all dressings dry and intact can help prevent post-operative 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.
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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
