Options After the Removal of an Achilles Tendon

Perhaps one of the most painful and debilitating injuries for an athlete, complete rupture of the Achilles tendon, can often lead to surgical removal of the tendon. At this point in the process, the patient and surgical team have a few options to consider in order to insure the best possible post-treatment outcome for the patient.

Function of the Achilles Tendon

• According to Dr. Stephen M. Pribut, the Achilles tendon is the connection between the heel and the most powerful muscle group in the body. The Achilles tendon joins three muscles: the two heads of the gastrocnemius and the soleus. The gastrocnemius heads arise from the posterior portions of the femoral condyles. The soleus arises from the posterior aspect of the tibia and fibula. This has long been known as a site prone to disabling injury, especially in highly active people. After injury and removal of this tendon, patients will have little to no range of motion in the ankle joint, thus drastically weakening the affected limb.

Ankle Joint Freezing

• One option patients may need to consider after tendon removal is having the surgeon permanently fix the ankle joint in a locked position. Dr. Pribut states that the Achilles tendon does not have a rich blood supply and is not invested within a true tendon sheath. As a result, the ankle joint is able to sustain tissue health without the connection of tendon blood flow. With permanent fixture of the ankle joint, the patient will be required to wear a protective boot for constant support around the lower leg. Gait and unassisted walking will be difficult, although not impossible. The patient will also typically be prescribed a physical therapy treatment plan in order to maintain extremity function.

Removal and Replacement

• Many patients may prefer to simply replace the ruptured tendon with tissue from an alternative site on their anatomy. According to a recent study, patients choosing to replace the ruptured Achilles tendon with fascia lata (a type of tendon tissue taken from the patient's connective femoral tissue) benefitted greatly from the procedure and often regained full range of motion in the ankle joint. Patients choosing this option will be faced with a longer rehabilitation process than with an ankle joint freezing; however, the long-term benefits may be dramatically higher following tendon replacement.