Achilles Detachment Re-attachment
Dr. Desai discusses Achilles Detachment Re-attachment surgery
ANIMATED VIDEO: Dr. Desai uses the Minimally Invasive Arthrex Achilles Speedbridge
LIVE VIDEO (WARNING): Dr. Desai performing a minimally invasive Haglund’s excision and Achilles tendon reconstruction.
Pre Operative Instructions
After your consultation with Dr. Desai, Ana will call you within 24-48 hours to book your surgery.
A few weeks before surgery, you will have a pre-operative visit with Dr. Desai’s team. The purpose of this visit:
Educate you on how to prepare for surgery
Review the post operative course
Providing mandatory devices needed for your surgery
Providing optional devices to help with your recovery
Dr. Desai recommends pre-operative immuno-nutrition to optimize your recovery. This will also be offered at your pre-operative visit:
Day of Surgery
Please refer to: Preparing for Surgery for full details on what to expect the day of surgery.
Right before surgery, you will be taken to the “block room” prior to the operating room. You will get a local nerve block by the anesthesiologist. A nerve block is local anesthetic (freezing) that will be injected around your nerves which freezes your leg. This is done under ultrasound guidance which ensures accuracy and safety. The nerve block avoids requiring a general anesthetic (GA) which requires a full intubation. You will still be given some medication to make you sleepy so you won’t hear, feel or remember anything.
If you prefer not to have a nerve block, or you have had a negative experience with a previous anesthetic, you will be able to discuss this with the Anesthesiologist prior to surgery. They will work with you to address your needs and anesthetic preferences.
The first 24 hours
The first 24 hours after surgery to me is the most important part of your recovery. The nerve block lasts around 12 hours or so. Therefore, in the middle of the night the nerve block will wear off and the pain will start. This is why I recommend starting your pain medications prior to going to bed. By starting your pain medication before the pain starts you have pain medication in your system as the nerve block wears off. This helps block your body’s pain response from ever happening. Nine out of 10 patients who follow these specific instructions have nearly no pain throughout their entire recovery.
You will be getting a prescription for Dilaudid (hydromorphone) which is a narcotic medication. If you have an allergy to this, I will give you a different medication. I recommend taking the Dilaudid before you go to bed. I recommend taking it every six hours. I also recommend taking Tylenol (acetaminophen) and Advil (ibuprofen) together every six hours. I recommend that you stagger these medications. For example, if you go to bed at 9 PM, take your Dilaudid, three hours later at midnight, take Tylenol and Advil, three hours later, take your Dilaudid again, etc:
This seems like a lot of medication, but all three medication’s work in very different ways to help manage pain. It is safe to take all three. I want you to have a good experience throughout your entire surgical journey and how do you manage your medication’s directly after surgery is extremely important to making sure you have a good overall recovery.
I would recommend you follow these instructions taking these medications for the first 48 hours only. After the first 48 hours, you can then just take Tylenol and Advil every six hours. Most patients are off all their medications within 2 to 3 days.
I will provide you with more than enough narcotic medication for your surgery. You will most likely not use all the pills provided. I always give a few extra in case. I do not provide refills for narcotics under any circumstance. In the rare circumstance you still have pain after 48 hours, I recommend taking Tylenol and Advil.
First 2 Weeks After Surgery
Pain:
After the first 24-48 hours you most likely will not require any pain medications. You may need the occasional Tylenol and/or Advil.
Devices:
After surgery you will be placed directly in the Vacocast Achilles Boot
If you did not purchase this, you will be placed in a cast for the first two weeks.
Wound/Dressing:
The boot or cast will remain until you see me back in clinic in 2-3 weeks post operatively.
Do not take your boot or cast off at anytime in the first 2-3 weeks.
Do not get your boot or cast wet. Use a bag or shower cover during your showers.
Weight Bearing:
If you have the Vacocast Achilles Boot you may fully weight bear on your foot immediately.
If you have a cast, you will be non-weight bearing.
You may need crutches to help. A knee walker is probably the best way to get around the first few weeks. I would highly recommend this.
Activity:
Please limit your activity. I would recommend doing your daily activities at home, but I would not recommend any significant activity, long walks, etc. as significant swelling may occur which will be painful and slow your overall recovery.
Light workouts are permitted, but remember, if you work out and sweat your surgical site will become wet which is not ideal for wound healing.
2 to 6 Weeks After Surgery
Appointment:
At your first post operative appointment (usually 2-3 weeks after surgery) we will remove your dressing and stitches.
Devices:
Vacocast Achilles Boot: You will be placed back in the Vacocast Achilles Boot with the angle set to 30o. Please refer to the therapy protocol provided to you at the time of surgery.
Aircast boot: If you did not purchase Vacocast Achilles Boot, you will be placed in an Aircast boot with heel lifts to keep your ankle plantar flexed (pointed downwards). I highly recommend the Vacocast but do understand it may be cost prohibitive.
Achilles Tendon Night Splint: If you purchased an Achilles Tendon Night Splint, you may use this when you are not walking (i.e. during the day when you are sitting, laying down, at night, etc.). The purpose of the splint is to keep your ankle pointed downwards (plantarflexed). If you do not have this splint, you can simply wear your regular boot 24/7 (VacoPed Pro Achilles Boot or standard walking boot). The boot may be removed for showers and when you are doing your exercises.
Game Ready: Game Ready is an optional ice compression machine. A sleeve wraps around your leg and ice water is pumped around your surgically repaired Achilles while simultaneously compressing your lower leg. This helps limit swelling and pain. You may remove your boot and use this 5-6 times per day. Use whatever setting on the machine which you can tolerate.
Wound/Dressing:
We will place small bandages called steri-strips. You may begin taking showers immediately; however, I do not recommend immersing the wound in water (bath, hot tub, pool, etc.) for 6 weeks total from the time of surgery. The steri-strips will slowly peel off themselves. There is no need to pull them off or replace them when they do fall off.
Do not place any creams/lotions etc. for 6 weeks.
Weight bearing:
You are permitted to fully weight bear with your boot on. Some patients struggle initially with walking, so you may use crutches if needed. A knee scooter is the best way to get around quickly the first few weeks.
Activity:
Please limit your activity. I would recommend doing your daily activities at home, but I would not recommend any significant activity, long walks, etc. as significant swelling may occur which will be painful and slow your overall recovery.
You may start exercising (upper body exercises, opposite leg and core exercises)
Therapy:
I recommend you see a therapist starting after the first post operative appointment. I generally recommend a therapist once a week from week 2 to 6 post operatively then 2-3 times per week from week 6 to 12 as this phase is more involved and intense. If you have good insurance coverage then you can certainly go more often. Humber River Hospital provides their patients with a few free sessions of therapy at the hospital. The therapy protocol is in the black folder given to you on the day of surgery. The protocol is also available here:
6-12 Weeks After Surgery
Devices
Vacocast Achilles Boot: At this stage, you may already be weaned off your boot or close to this. In general, most patients are out of their boot somewhere between 6 and 8 weeks after surgery. If you haven’t weaned off the boot yet, you may remove the boot at night.
Achilles Tendon Night Splint: If you feel more comfortable you can use the Achilles Tendon Night Splint, but it is not necessary at this stage.
Heel Cups: Used after your boot is removed and you start using your regular shoes. They are used for 6 months total.
Game Ready: An optional ice compression machine. A sleeve wraps around your leg and ice water is pumped around your surgically repaired Achilles while simultaneously compressing your lower leg. This helps limit swelling and pain. You may remove your boot and use this 5-6 times per day. Use whatever setting on the machine which you can tolerate.
Compression Socks: Used after surgery in order to decrease swelling. Medical grade compression recommended (20-30mmHg pressure). Starts between 6-12 weeks post-operatively. Starting at 6 weeks is ideal, but some patients feel more comfortable putting the socks on later in their recovery (8-12 weeks post-operatively).
Weight Bearing
You are permitted to fully weight bear.
By the time the boot is weaned off, you will be able to walk in your regular shoes with your heel cup.
Activity
At this stage, you can begin getting back to your activities with no limitations. Keep in mind, the highest risk of re-rupture is between 6 and 12 weeks. During this time, I do not recommend any sports requiring push-off activities such as basketball, football, pickleball, tennis, etc. Any sport requiring a quick push-off needs to be avoided during this stage. Activities such as walking, treadmill, elliptical, bike, etc. are all recommended.
Therapy
I recommend you see a therapist 2-3 times a week if possible. The therapy protocol is in the black folder given to you on the day of surgery. The protocol is also available here:
12+ Weeks After Surgery
Appointment
Your 12-week appointment is your final appointment.
Devices
Heel Cups: Used after your boot is removed and you start using your regular shoes. They are used for 6 months total.
Game Ready: An optional ice compression machine. A sleeve wraps around your leg and ice water is pumped around your surgically repaired Achilles while simultaneously compressing your lower leg. This helps limit swelling and pain. You may remove your boot and use this 5-6 times per day. Use whatever setting on the machine which you can tolerate.
Compression Socks: Used after surgery in order to decrease swelling. Medical grade compression recommended (20-30mmHg pressure). Starts between 6-12 weeks post-operatively. Starting at 6 weeks is ideal, but some patients feel more comfortable putting the socks on later in their recovery (8-12 weeks post-operatively).
Activity
At this stage, you may begin sport specific training. This includes jogging, running, strengthening, etc. I do not recommend any sports requiring push-off activities such as basketball, football, pickleball, tennis, etc. Any sport requiring a quick push-off needs to be avoided until closer to 5 months post operatively.
Therapy
I recommend you see a therapist 2-3 times a week if possible. The therapy protocol is in the black folder given to you on the day of surgery. The protocol is also available here: