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Surgical Treatment of Achilles Tendinitis and Posterior Heel Spurs

Surgery
Elective Achilles' tendon surgery is performed to treat partial tears in the tendon, remove calcified areas in the tendon, and / or remove an inflamed bursa and bone spurs at the back of the heel.

                       Heel Spur Incision.jpg

The surgery is usually performed through an incision on the back of the lower calf or heel. In some cases the incision will be made on the inside or outside of the heel. A 3 – 4 inch scar in the skin is usually the result. The tendon is repaired after any pathological area is removed. 

   Heel Spur.jpg      Heel Spur Excised.jpg

Heel spurs are excised if present, and calcifications in the substance of the tendon are also cut out.   

This is done as an outpatient procedure, and you will require a General anesthetic.

Day of Surgery
At the end of the surgical procedure the wound is covered and a Short Leg Plaster Splint is applied with the toes pointing downward (plantarflexed ankle). That dressing gives support to your ankle, holding it securely. You should leave that in place until I change it at the first post-operative office visit.

You will be given crutches at the surgery center, and I want you to not put any weight on that leg during the first week. Do not walk on the splint.  If the splint gets wet or there is a problem with it, please call the office so I can remove it myself.

Look here for things to watch for after Outpatient Surgery.

Post-operative Course
Dealing with post-operative pain will be your major concern for the first few days.

Most people find that for the first few days after surgery their ankle will feel better if it is elevated. Generally, if you let it hang down for any period of time it will throb and you may have more swelling. You can put it into whatever position feels best, but usually that will be elevated with a pillow under the foot.

The first post-operative visit is usually 7 – 10 days after surgery. I will remove the splint and dressings, wash your leg, and take out the Skin Stitches.

I will usually prescribe a CAM Walker, a removable walking boot, and you will use that for protected weightbearing until 6 weeks after surgery. After 6 weeks a shoe may be worn for walking. Running and jumping activities should be avoided until 3 - 4 months after surgery.

In some instances I may recommend that a Short Leg Walking Cast be used until 6 weeks after surgery. That decision is made depending on the findings at the time of surgery. If that is the case, the CAM Walker would be used for protected weightbearing for 6 weeks after the walking cast. The course of recovery will be delayed 6 weeks.

The CAM Walker must be used for protected weightbearing until 3 months after the surgery. It may be removed for bathing, when sleeping at night, and to do gentle active exercises. Sporting activities are not resumed until 6 – 9 months after surgery.

Final Results
The goal of the surgery is to leave you with a painless foot and leg that will allow normal activities. You should be able to regain full strength and power in the calf, and have no restriction of motion. Some patients will have some mild soreness still. Some will notice discomfort when the weather changes.

Complications
Complications can occur with any surgery.  Go here for a general discussion of Surgical Complications. 

Specific risks of this procedure include persistence of pain, and recurrence of calcifications about the heel or tendon.




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