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ACHILLES TENDON DEBRIDEMENT AND REPAIR

Achilles tendinosis is thickening of the Achilles tendon.  This may be caused from an injury/trauma or from overuse.  The tendon becomes inflamed and eventually the thickening occurs and a lump develops.  This may be painful with pressure from shoe wear or may be activity related.  This area is a difficult area to heal itself, due to decreased blood flow.  Conservative treatment consists of anti-inflammatories, immobilization with a CAM walker, a heel lift, and physical therapy.  As symptoms progress, surgery may be required.  An MRI is usually obtained prior to surgery to determine the degree of tendinosis.  During surgery the damaged part of the Achilles tendon is removed and a synthetic material is used, called a graft jacket, to reinforce the tendon.  The surgery is generally successful.  As with any surgery, risks are involved.  These include infection, numbness, and bleeding.  We try hard to make your experience as pleasant as possible.  We have found the following points helpful following surgery

1. We use a re-circulating cold water unit called a “polar pack.”  Mark with Pacific Medical will contact you and have you pick this up before surgery.   Please bring this with you as it will be applied during surgery,  It is important that you turn the polar pack off every two hours for 15-20 minutes to prevent your foot and ankle from becoming too cold.  The polar pack can cause frostbite if left on too long.  The polar pack helps greatly with reducing swelling which helps decrease your pain.
   
2. Elevation helps with both pain and swelling.  You need to elevate your foot above your left shoulder constantly the first 72 hours and this is helpful for the first 10 days.  You will have some swelling for up to six months following surgery.  This is normal. 
3. You will be placed in a post-operative splint following surgery.  This will remain in place for the first 10-14 days, until your post-op appointment.  You will need to be non-weight bearing during this time.  At your post-op appointment we will remove your splint, remove your sutures, and place you in a short leg cast for 4 more weeks, non-weight bearing.  We will see you back at six weeks from surgery, remove your cast and place you in a CAM walker and let you begin to weight bear as tolerated.
4. Since you will be non-weight bearing for six weeks following surgery, you will need crutches, a wheelchair, or a rollabout.  We can write you a prescription for one of these items and your insurance should pay for it.  Attached is a list of providers for these items. 
5. In order to minimize pain after surgery, we generally use regional anesthesia, called a popliteal block, you will have no pain for 6-18 hours after surgery.  During this time your foot and ankle will be numb and will not support you.  In addition, it is important that you begin your pain medication before this block wears off as to get the medication in your system and working.  Generally we recommend you start taking the pills when you get home from surgery and then take them consistently around the clock the first 24 hours.  Set your alarm clock to awaken during the night.  This will help you transition from the block to oral medication.  After the transition is completed you may take the medication as needed for pain.  Below are listed the common medications and their dosages
   

• Norco (hydrocodone) take 1 pill every 2 hours as needed for pain
• Darvocet (propoxaphene) take 1-2 pills every 4 hours as needed for pain.
• Oxycodone take 1-3 pills every 2-3 hours as needed for pain
• Vistaril (hydroxazine) take 1 pill every 4 hours as needed to minimize nausea
  and it also helps to make the pain medication seem more effective
• Phenergan (promethazine) take 1 pill every 4 hours as needed if you
  develop nausea.

If you have questions or concerns please feel free to contact your physician's nurse at
323-2600.