Achilles Tendon Repair Surgery Cost and Procedure Guide

Goals of Achilles tendon repair surgery

Achilles Tendon Repair Surgery, also known as Achilles tendon rupture surgery, aims to repair a torn (or ‘ruptured’) Achilles tendon by sewing together the tendon ends of the patient’s Achilles tendon. This promotes healing and avoids weakness that will interfere with walking or sports activities.

A large proportion of Achilles tendon ruptures are treated with a non-surgical method such as functional bracing (where a patient wears a rigid boot until the tendon is healed). However, there are many cases where surgery may be preferred, for example, when the patient presents to their primary care doctor many weeks after the initial injury, atypical or large ruptures, or for athletes and those who engage in a lot of exercise.

Achilles Tendon Repair Surgery is performed after injury but when the inflammation has decreased, normally 4–6 weeks after the accident. Recovery from the operation may be up to 9 months and include physiotherapy.

Cost of Achilles tendon repair surgery

Achilles tendon repair surgery is bespoke and personalised towards the needs of each individual patient, and the surgical technique needed can differ. Therefore, it is not possible to give an exact quote without being assessed first. Various factors that can influence the cost include the number of follow-up appointments, necessary physiotherapy appointments, the type of anaesthesia used, and how many scans are required. The package price usually costs between £1900 to £3600.

The patient may also choose to purchase a plastic cover to protect the ankle from water when it is wrapped in a plaster cast.

Ideal candidates for Achilles tendon repair surgery

Typically, patients with Achilles tendon injuries are 30 to 40-year-old men who present with sudden ankle or calf pain during recreational sports. Achilles tendon rupture affects approximately 18 per 100,000 people per year.

Surgery is usually more suited for younger patients that still lead active lifestyles. In older patients that are not so active, conservative treatments may be more recommended.

The surgery team will discuss the risks and benefits of the surgery with the patient and advise whether Achilles tendon replacement surgery is right.

The Achilles tendon repair surgery procedure

When a patient receives Achilles Tendon Repair surgery, they will receive general anaesthetic (while asleep). In circumstances where the patient is not able to receive a general anaesthetic, the surgeon will recommend that the patient receives spinal or regional anaesthetic to numb only the leg.

Once the patient receives anaesthetic, the surgeon will make a small surgical cut by the Achilles tendon on the back of the ankle, then identify the two ends of the Achilles tendon and stitch these back together. This can be achieved by either open surgery, where a single large incision is made on the back of the leg, or percutaneous surgery, where several smaller incisions are made instead of one large one.

If the Achilles tendon rupture is too large for the tendon ends to be brought back together, the surgeon will bridge the gap with a nearby tendon (a commonly used one is lexor hallucis longus tendon).

The surgeon will then close the incision with stitches, and the patient will be given a local anaesthetic (applied only to the area that has received surgery) to help with pain relief for the first few hours after surgery. The procedure normally takes approximately 30 minutes.

The surgery team will place the Achilles tendon into a temporary plaster cast with the foot pointing downwards. This protects the area that needs to heal.

What will happen at an initial Achilles tendon repair consultation?

The orthopaedic surgeon will assess the ankle and ask patients to describe their symptoms and how it affects their life, and the onset/cause of the discomfort or pain. Surgery may not necessarily be recommended initially, and non-surgical treatments may be advised. If this is the case, a comprehensive plan will be given.

If surgery is considered the best option, the surgeon will discuss how the surgery will be performed, including the techniques, anaesthetic to be used, aftercare planned and the risks and complications.

Taking a complete list of medications is helpful as the surgeon will give advice if any need to be stopped before surgery.

Any questions the patient has will be answered within the consultation; it’s a good idea to write everything done prior to meeting the surgeon, so nothing is forgotten.

Ultrasound may be required (including a particular type called dynamic ultrasonography), X-rays or magnetic resonance imaging (MRI) so that the surgery team can examine the Achilles tendon and the extent of the injury.

Other tests may include electromyography (EMG) – a technique that measures the muscle’s electrical activity, and nerve conduction studies, which measure the speed of electrical impulses through the muscles.

Preparing for Achilles tendon repair surgery

It is important that the surgery team know about all the medicines the patient takes. This includes over-the-counter medicines such as ibuprofen or aspirin. The surgery team will also need to know about any recent changes in the patient’s health, for example, fever.

General Health

• Stop smoking
  • Smoking is shown to slow the healing of soft tissue and bones
• Weight loss
  • If the patient is overweight, weight loss will help to reduce the pressure on the ankle.

Prepare the home

• The patient will need to have their foot elevated for a few weeks following surgery. Having extra pillows for lying down or having a footstool can help
• Consider how best to bathe.
  • While the patient’s foot is wrapped in a plaster cast, they may want to use a cast protector or plastic bag to prevent the cast from getting wet.
  • A doctor or nurse will be able to provide guidance on how best to wash without getting the ankle wet.
• The patient may want to stock up on groceries ahead of surgery
• The patient’s mobility will be affected, especially during the first few weeks. Having everything needed, such as crockery, in easy-to-reach places will help
• The patient may want to move any unnecessary appointments (such as hairdressers)

It is important to make sure that the patient has someone to pick them up from the hospital, as they will not be able to drive for several weeks after the surgery.

Planning childcare, pet care and time off work will allow patients to have a smooth recovery period and know that everything is being taken care of while they rest their ankle.

The patient will need to plan for some changes at home following the surgery and won’t be able to walk normally until the Achilles tendon is fully healed.

Achilles tendon repair surgery aftercare and recovery

The vast majority of patients can go home on the same day as the surgery. If they have other significant medical problems, they may be asked to stay overnight. The physiotherapist will check that the patient is safe to move around using crutches.

The rehabilitation process is, on average, 6–9 months.

The following would be typical of a recovery journey, though this is really for an indication as your own recovery may vary from this.

Immediately after the surgery, the patient’s foot will be wrapped in a plaster cast, and the surgery team will advise the patient to avoid putting weight on the foot, elevate their leg as much as possible, and avoid getting the plaster cast wet – a waterproof cover may help with this.

The patient will have a follow-up appointment approximately two weeks after surgery. The surgery team will remove the plaster cast, dressing and stitches and apply a walking brace with a hinge. This will allow the patient’s ankle to move from 15–45 degrees downwards. From here, the patient can start to gradually apply weight to the foot when walking.

Two weeks after this (at week 4), the patient will have another follow-up appointment. The surgery team will adjust the brace, and the patient will be able to apply more pressure and weight to their foot than before. They will also be able to bend their ankle, so it is in a fully neutral position and fully bend it down. They may be able to stop using crutches at this point.

At week 8 after the operation, the patient will start physiotherapy, continuing until the physiotherapist sees that they have enough strength in their calf to resume normal walking.

Returning to work

If the patient has a desk-based job where they are able to elevate their foot, they can return to work two weeks after surgery. If their job is physically strenuous, they may need longer off work to recover, up to 12–16 weeks.

Driving

The patient can start driving again after the plaster cast has been taken off and they are comfortable walking in their own footwear. If they cannot safely make an emergency stop, their insurance will not cover them in the event of an accident.

Playing sports

The time after surgery until the patient can start playing sports again will vary from person to person. As a rough guide, they will be able to run at approximately 6 months after surgery and aim to return to full sporting activities after 9 months. The physiotherapist will help them to restore their strength and balance to their pre-injury levels.

It is important that the patient follow their surgery team’s guidance around recovery, to minimise any risks for post-operation complications. Each individual will have unique needs and requirements, and the surgeon will advise accordingly. Our physiotherapists are highly-trained experts with decades of experience between them and are on hand to provide the best possible care and rehabilitation.

All operations carry risk. The risks of Achilles tendon repair surgery are usually related to the anaesthetic and surgical procedure.

The surgery team, normally the anaesthetist, will discuss the anaesthetic options and associated risks before the patient chooses to proceed with surgery. The risks of general anaesthetic vary depending on the patient’s general health.

There are other surgical risks the surgery team will discuss with the patient. These include:

• Blood clots: Surgical and non-surgical methods to treat a ruptured Achilles tendon may increase the risk of developing a blood clot in the injured leg or the lungs. The patient will be individually assessed, and if necessary, they may be given blood thinning medication to reduce the risk of developing a blood clot. The patient may also be at an increased risk of developing a blood clot in one of the deep veins in their body (usually in the leg; deep vein thrombosis or DVT) if they are taking an aeroplane flight after recent surgery. The surgery team will provide guidance on how long to delay their flight, as this will vary from individual to individual.
• Nerve injury: Most operations carry a small risk of injuring or stretching nerves that are nearby to the surgical area. This can cause numbness or weakness. These symptoms will normally resolve over time, but in some cases, they persist.
• Infection: Infection occurs in approximately 5 of 100 foot or ankle operations. The majority of these are minor infections that are treated effectively with antibiotics. In very rare cases, antibiotics are not effective, and they may require another operation.
• Delayed wound healing: After surgery, some patients may take longer than the average amount of time (6–9 months) for their ankle to heal. This may mean that they need another operation with a plastic surgeon. People who smoke have a greater risk of this complication compared to those who do not.
• Re-rupture: There is a very small chance of re-rupture. This is normally due to excess weight or stress being applied to the surgery area too early post-surgery.
• Chronic regional pain syndrome: A very small proportion of patients can develop a painful, swollen and sensitive foot. This may require specialist care from a pain consultant.

If the patient has diabetes, neuropathy or a vascular condition, they will need to check their skin twice a day to make sure that no sores are starting to form.

This list is not exhaustive. The surgery team will be able to provide further information.

NHS Cambridge University Hospitals. Achilles tendon rupture. Available at: https://www.cuh.nhs.uk/patient-information/achilles-tendon-rupture/ Accessed 31 October 2022.

Milton Keynes University Hospital. Achilles Tendon Repair Surgery. Available at: https://www.mkuh.nhs.uk/patient-information-leaflet/achilles-tendon-repair-surgery Accessed 31 October 2022.

Royal Orthopaedic Hospitals. Tendoachilles reconstruction with FHL transfer. Available at: https://roh.nhs.uk

Royal United Hospital Bath. Acute Achilles Tendon Rupture Advice Sheet. Available at: https://www.ruh.nhs.uk/patients/services/clinics/orthopaedic_fracture/documents/Acute_Achilles_Tendon_Rupture.pdf Accessed 31 October 2022.

Johns Hopkins Medicine. Achilles Tendon Repair Surgery. Available at: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/achilles-tendon-repair-surgery Accessed 31 October 2022.

Khan-Farooqi W & Anderson RB. Journal of Musculoskeletal Medicine. 2010;27;5.

Khan RJK, Carey Smith RL. Surgical interventions for treating acute Achilles tendon ruptures. Cochrane Database of Systematic Reviews 2010, Issue 9. Art. No.: CD003674. DOI: 10.1002/14651858.CD003674.pub4.

Park HS, et al. Clin Orthop Surg. 2020 Mar; 12(1): 1–8. doi: 10.4055/cios.2020.12.1.1

Movin T, et al. Foot Ankle Clin. 2005;10(2):331-56. doi: 10.1016/j.fcl.2005.01.003.