🦶 Achilles Tendon Surgery – The Start of the Comeback
❓ Simple Definitions
- Achilles tendon: The strongest tendon in the human body – connects calf muscles to the heel.
- Plantaris tendon: A thin tendon in the lower leg – often used for reinforcement in surgery.
- Mason-Allen technique: A special suture method with crossed stitch pattern – very stable.
- Tubularization: Restoring the tendon’s round shape with side stitches.
- Soleus: A deep calf muscle – works closely with the Achilles tendon.
- Stripping: Surgically removing a tendon using a special tool.
- Paratenon: The sliding layer around the tendon – key for movement.
- Vicryl suture: An absorbable surgical thread – used inside the stitch.
- Drain: A tube to drain wound fluid after surgery.
- VACOped: An orthopedic shoe with adjustable angle – replaces a cast.
- General anesthesia (intubation): Entire body in deep sleep, ventilated via a tube in the windpipe.
- Spinal anesthesia: Numbs body from the waist down via an injection in the spine – patient stays awake.
🔍 Minimally Invasive vs. Open Surgery – A Comparison
| Minimally Invasive | Open Surgery | |
|---|---|---|
| Access | Very small incisions (often < 2 cm) | Large incision with direct view |
| Technique | Sutures mostly blind or via camera | Sutures under direct control, with possible reinforcement |
| Advantages | Faster wound healing, better cosmetics | Higher stitch quality, better tendon alignment |
| Disadvantages | Higher risk of misalignment, re-rupture | Longer healing, higher infection risk |
| When Suitable? | Partial tear, very clean rupture | Complete tear, large hematoma, athletic patient |
🩺 Why Operate at All?
An Achilles tendon tear is serious. For active people the question is: operate or not? In my case, the tendon was fully torn and the gap was clear. Conservative treatment with a brace was not an option. I wanted full load capacity again, with maximum stability and low risk of another tear.
We chose open surgery with extra support from the plantaris tendon.
🛠️ What Was Done – Surgery Steps in Simple Terms
Surgery date: May 7, 2025
Anesthesia: General anesthesia (intubation)
Duration: about 90 minutes
🧬 What Is General Anesthesia – And the Alternative?
This surgery used general anesthesia with intubation. The body goes into deep sleep. Breathing is via a tube in the windpipe. The patient feels nothing and is fully monitored.
The alternative is spinal anesthesia. Only the lower body is numbed via an injection in the spine. The patient stays awake but pain-free. For complex, longer surgeries with muscle access, general anesthesia is standard.
1. Creating Access & View
The leg was sterilized and a tourniquet applied. The cut was on the inner side of the heel. We cut vertically through skin and tissue with precision, avoiding unnecessary damage.
2. Exposure & Prep
We opened the paratenon by hand. We exposed the plantaris tendon. We removed hematoma remnants and exposed the muscle origins, especially the soleus. The goal was to keep tendon fibers intact.
3. Interlocking Suture Technique
We used the Mason-Allen technique. We wove the tendon ends together in 3–6 passes. We added a frame stitch for stability and round shape. We reattached the soleus without strangling fibers.
4. Reinforcement with Plantaris Tendon
We stripped the plantaris tendon. We passed it through the repaired Achilles in several directions. We fanned it out for extra support and even load distribution.
5. Closure
We placed a drain in front of the tendon. Then layered skin closure, dressings, steri-strips and a brace at 120° plantarflexion. Post-op: leg elevation, thrombosis prevention (Inhixia), in-hospital physiotherapy.
🧊 The First 48 Hours – “Surgery Success, Now No Risks!”
- Leg elevation, cooling, no weight
- Daily thrombosis injections (40 mg Inhixia or Xarelto if needle-afraid)
- Pain meds as needed
- First mobilization with crutches – only sole contact, no walking
- Dressing change after 48 h, discharge with VACOped shoe if healing is stable