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Surgery for Achilles Injury

NYU Langone doctors may recommend surgery to treat an Achilles injury.

Surgery is typically the treatment of choice for an Achilles rupture, especially in active individuals who want to return to sports and work that requires strenuous physical activity. Surgery is an option for both partial and complete ruptures.

Surgery may also be recommended for people with Achilles tendinitis that has not healed with a comprehensive physical therapy program.

We offer outpatient minimally invasive and open approaches for repairing an Achilles injury. Your doctor can help you decide what the best option is for you.

Surgical procedures are usually done on an outpatient basis and take about 30 to 60 minutes. They are followed by a comprehensive postsurgical care and rehabilitation program. Full recovery from an Achilles injury and surgery may take nine months to a year.

Our specialists may also recommend a biologic therapy, a medicine made from biological sources such as cells and proteins, to help with healing after surgery.

Surgery for Achilles Rupture

Percutaneous repair, open repair, and tendon transfer are different types of surgery for Achilles rupture.

Percutaneous Achilles Repair

Our surgeons perform Achilles repair using a minimally invasive percutaneous technique, in which they make several tiny incisions in the skin along the back of the calf. The surgeons pass tools through these incisions that they use to remove damaged tendon tissue. They then use needles and sutures to repair a partially torn tendon or to connect the ends of a severed tendon together. The surgeon may also need to attach the tendon to the heel bone using sutures and small plastic screws drilled into the bone. After the repair, your surgeon closes your incisions with sutures. Making several small incisions instead of one long incision helps prevent wound complications, encourages a faster recovery, and reduces scarring.

Open Achilles Repair

In open Achilles repair, your surgeon makes an incision on the back of the calf and locates the partially ruptured tendon or the ends of the completely severed tendon. They then remove any damaged tissue and use high-strength sutures to repair the tear or secure the ends of the severed tendon together. Your surgeon may also attach the tendon to the heel bone with sutures and surgical screws. Sutures are then used to close the incision. The back of your calf may be tender and swollen for a several days after the procedure.

Tendon Transfer

If the Achilles tendon has extensive damage, is completely severed, or is too short to be sewn back together, your doctor may recommend a tendon transfer. For this procedure, your surgeon repositions the tendon that is responsible for flexing the big toe. This tendon, known as the flexor hallucis longus, runs along the back of the calf and the inside of the ankle and foot. The surgeon makes two to three incisions in the ankle and calf to disconnect the flexor hallucis from the big toe and to anchor it to the heel bone using a plastic screw. The tendon is sutured to the Achilles to help reinforce it. The surgeon closes the incisions with sutures. You may experience some pain in the calf and ankle and weakness in the big toe immediately after surgery. However, function of the foot remains intact, because other muscles that move the big toe take over.

Surgery for Achilles Tendinitis

If physical therapy does not help heal Achilles tendinitis, your doctor may recommend surgery. Options include gastrocnemius recession surgery and Achilles tendon debridement.

Gastrocnemius Recession Surgery

Gastrocnemius recession surgery lengthens one of the two muscles in the calf. A tight calf muscle can interfere with Achilles tendon flexibility. The procedure may be beneficial in people who have difficulty flexing their feet, even after months of calf stretches in a physical therapy program.

The procedure can be performed with a conventional, open incision or with a small incision and an endoscope. An endoscope is a long, thin tube that contains a small camera that surgeons insert through a tiny incision to see the calf muscles. The surgeon can then pass surgical tools through a small working channel. To lengthen the calf muscle, your doctor makes an incision through the fascia, the tight layer of connective tissue surrounding the muscle. This incision allows the muscle to relax and lengthen. The doctor closes incisions made in the skin with sutures.

Achilles Debridement

During Achilles debridement, your surgeon makes an incision along the back lower portion of the leg and removes damaged parts of the Achilles and repairs the remaining tissue with sutures. If more than half of the Achilles is damaged, your surgeon may also perform a tendon transfer, in which the tendon that flexes the big toe is repositioned to help the remaining Achilles tendon to function.

Surgical Biologics

Your doctor may recommend using biologics to enhance healing from a procedure. Options include a collagen patch or postsurgical platelet-rich plasma (PRP) injections.

Collagen Patch

Your surgeon may place a collagen-based patch on your Achilles tendon during your procedure to help with healing. Collagen is a protein that is a main element of tendons, ligaments, and muscles. These patches work at the cellular level to help with Achilles tendon repair, but they are not meant to replace damaged tissue. They dissolve with time and do not need to be removed.

Postsurgical Platelet-Rich Plasma Injections

Our doctors may discuss the potential benefits of using platelet-rich plasma injections to augment surgical repair of Achilles injury. Platelet-rich plasma is made of blood cells called platelets that are removed from your body. Platelets release substances called growth factors, which can stimulate healing.

Our Research and Education in Achilles Injury

Learn more about our research and professional education opportunities.