Insertional Achilles Tendinopathy Surgery

Insertional Achilles Tendinopathy Surgery Information Sheet

Insertional Achilles Tendinopathy Surgery Procedure

  • The surgery involves an incision over the achilles insertion the bone spur and bursa are removed.
  • A wedge of bone is removed from the calcaneum, and the calcaneum is shortened to offload the Achilles; the calcaneum is then fixed with a screw.
  • A tendon transfer is performed to improve strength and blood supply to the repair, and help the degenerate Achilles to heal
A mri of a person 's ankle showing achilles tendon and inflamed bursa

The Hospital Stay

  • You wake up with bulky bandages, a boot or a half plaster.
  • You will stay in the hospital overnight, with your foot elevated and you have will have antibiotics through a drip.
  • You will be given blood thinners to prevent DVT and vitamin C to help with wound healing and pain management.
  • You will be only allowed to touch your foot to the ground for 2-3 weeks.
  • Depending on your balance and strength, you may need rehabilitation postoperatively.
  • Buying a second-hand knee scooter preoperatively (you can search online) and practising at home before the surgery can be helpful; please bring it into the hospital with you. It is easier to use a knee scooter than crutches.


When You Go Home

  • You will need medications for pain relief.
  • You will need to take antibiotics until the wound heals.
  • You will need blood thinners and vitamin C daily for 6-8 weeks.
  • Please leave all dressings intact until your post op appointment.
  • You will get an appointment for your post op appointment in 2-3 weeks where the dressings will be taken down.
  • After this, you will be able to shower normally and pat the dressings dry.


Insertional Achilles Tendinopathy Surgery Rehabilitation

All patients are different. These timelines are only a guide; some patients may progress faster or slower than others.


0-3 Weeks

  • You will be in a boot or half a plaster.
  • You will only be allowed to touch your foot to the ground for balance.
  • You will need to bag the leg for showers.
  • Pain relief: Please take regular paracetamol with meals and before bed; you may need stronger painkillers as well, especially before bed.
  • Please take antibiotics, blood thinners and vitamin C as prescribed.


3-8 Weeks

  • Post op appointment for a wound check.
  • You will then go back into the boot, but can remove it for seated showering and physiotherapy.
  • You can start partial weightbearing in the boot (20-50% body weight) and increase to full weightbearing in the boot over 4-5 weeks.
  • Physio for the isometric calf strengthening, hip and knee strengthening and leg lifts, and active range of movement below neutral with physiotherapy.


8-12 Weeks

  • Post op appointment to assess range of motion.
  • You can weight-bear as tolerated in a normal supported sneaker.
  • Physiotherapy for active plantarflexion and dorsiflexion to neutral, resisted inversion/eversion with the foot in neutral, and proprioception training (pain-free).


12 Weeks

  • Continue strengthening without restrictions except no landing/twisting/turning.
  • You can range the ankle past neutral with physiotherapy.


4-6 Months

  • You can progress strengthening and range of motion with pain-free double leg heel raises with physiotherapy.
  • Light jogging can commence if there is no pain.
  • You can walk bare footed.


9-12 Months

  • When the leg feels back to normal and the same as the other leg, you can start sport-specific training.


When Can I Return To Work?

  • Seated work 6-12 weeks
  • Prolonged standing 6 months
  • Heavy labour work 12-18 months


When Can I Return To Sport?

  • Start sport-specific training at 12-18 months.
  • Return to sport when the leg is the same as the other side


When Can I Drive?

  • Left foot 2-3 weeks (if driving an automatic)
  • Right foot 6-8 weeks


Insertional Achilles Tendinopathy Surgery Risks

  • Anaesthetic problems
  • Nerve injury
  • Blood clots
  • Infection
  • Stiffness
  • Rupture
  • Ongoing pain including chronic regional pain syndrome
  • Further surgery


If you want more information or have any questions or problems, please contact Dr Graff at admin@christygraff.com or call the rooms at 0493 461 133.