Achilles Tendon Repair – From Open to Percutaneous Techniques

Achilles Tendon Repair – From Open to Percutaneous Techniques Restoring Function to Your Injured Achilles Tendon Your Achilles tendon is the strongest tendon in your body, but it's also vulnerable to injury. When it tears—whether from a sudden rupture or chronic overuse—you lose the ability to push off when walking, running becomes impossible, and pain can be severe. Modern Achilles tendon repair surgery offers excellent outcomes using both traditional and minimally invasive approaches. At Central Florida Foot & Ankle Institute, we choose the technique that best matches your injury and lifestyle. The Achilles tendon connects your calf muscles to your heel bone. With each step you take, this tendon bears enormous force. A rupture is a serious injury requiring surgical repair for most patients. Understanding Achilles Tendon Injuries Achilles injuries fall into two main categories: Acute Rupture – A sudden tear, usually from forceful push off (sports, jumping, running). You feel a sharp pain, often describing it as "being kicked in the heel." Immediate swelling and inability to push off typically follow. Chronic Tendinopathy – Gradual degeneration from overuse, tight calf muscles, or age related changes. Pain develops slowly, often worsening with running or jumping. Eventually, the weakened tendon can rupture with minimal trauma. Who Gets Achilles Tendon Injuries Athletes – Especially runners, basketball players, and those doing explosive movements. Overuse and inadequate recovery cause most injuries. Middle Aged Adults – Sedentary work week followed by intense weekend activities increases injury risk. Fluoroquinolone Antibiotic Users – This class of antibiotics weakens tendon tissue, significantly increasing rupture risk. People with Inflammatory Conditions – Rheumatoid arthritis, ankylosing spondylitis, and psoriasis increase tendon fragility. Tight Calf Muscles – Chronically tight calves increase stress on the tendon. Symptoms Indicating Achilles Injury You should seek immediate care if you experience: Sudden sharp pain in your heel or calf Audible or felt pop in your heel Inability to push off when walking Difficulty rising onto your toes Significant swelling in your heel area Bruising along your heel or lower calf Weakness in your calf or ankle Achilles injuries don't improve on their own. Early diagnosis and treatment give you the best chance for full recovery. Diagnosis and Imaging We diagnose Achilles injuries through: Physical Examination – The Thompson test (squeezing your calf while you're prone) identifies ruptures. A positive Thompson test (no foot motion when calf is squeezed) indicates complete rupture. Ultrasound – Real time imaging shows the tendon, visualizes tears, and confirms rupture location. MRI – Provides detailed images showing partial tears, degeneration, and surrounding tissue involvement. Early imaging is crucial because some ruptures are partial rather than complete, and this affects treatment decisions. Conservative Treatment for Partial Injuries Small partial tears or severe tendinopathy might be managed without surgery: Complete rest – No running or high impact activities Cast or boot immobilization – Keeping your Achilles in a shortened position for 6 12 weeks Anti inflammatory medications – NSAIDs reduce pain and swelling Ice and elevation – After activity, these minimize swelling Physical therapy – After initial healing, gentle stretching and strengthening Corticosteroid injections – Anti inflammatory medication into affected areas (though injecting directly into tendon is controversial) Eccentric strengthening – Specific exercises that promote tendon healing However, complete ruptures require surgical repair to restore function. Open Achilles Tendon Repair Traditional open repair has been successful for decades: The Procedure: 1. Surgeon makes a 2 3 inch incision in the back of your lower leg 2. Visualizes the torn tendon ends directly 3. Brings the tendon ends together 4. Repairs them with surgical sutures (often using a weaving technique that strengthens the repair) 5. May use reinforcing tissue (fascia, artificial material, or platelet rich plasma) to strengthen the repair 6. Closes the incision Advantages: Direct visualization ensures perfect tendon alignment Able to reinforce the repair with additional tissue Proven long term success (90%+ return to full function) Well established surgical technique Disadvantages: Larger incision means more tissue trauma Higher infection risk (though still low) Longer swelling recovery Scar tissue can cause stiffness Longer rehabilitation period Percutaneous (Minimally Invasive) Repair Newer percutaneous techniques offer an alternative: The Procedure: 1. Surgeon makes 2 3 small (1 cm) incisions 2. Uses specialized instruments to pass sutures through the torn tendon 3. Brings the tendon ends together through these small incisions 4. All work is done percutaneously (through the skin) with minimal direct visualization 5. No tendon visualiz