I'm lined up for surgery to help me with a long-standing problem with my Achilles tendon. The surgeon calls it a tendinopathy from an old Achilles tendon injury that was never treated. The surgery is in two parts. First, clean out the old, diseased tissue. Then use my big toe flexor muscle to replace the bad Achilles tendon. My question today is: what should I expect for recovery after this type of surgery?
There are small studies with results published for this type of procedure. We found three studies with 20 to 26 patients and another larger study with 48 patients. Results were similar for all three studies. We'll fill you in on the larger one. The study of 48 patients included adults between the ages of 44 and 64. They were all fairly inactive and overweight (actually in the obese category with a Body Mass Index of 30 or more). Everyone was followed for two years. Results were reported based on improvements in pain intensity, physical function, and disability. Ability to rise on one foot (called a single-leg heel rise) and balance were also evaluated for any changes. The authors reported significant improvement in all areas except the single-leg heel rise. But even though the heel-rise was not normal (due to loss of toe motion and weakness), no one seemed to be having any trouble walking normally. No one seemed to be having any problems with balance. Both of these functions do depend on the flexor hallucis's ability to flex or bend the big toe. And almost everyone (97 per cent of the group) had no difficulty walking in sandals (keeping them on the feet). Keeping track of when patients experienced improvements, there were significant benefits from the surgery in the first three months. Improvements continued to be seen at the end of six months, 12 months, and even after 24 months. Most of the changes took place in the first year after surgery. There were a few minor problems and complications associated with the surgery. A couple patients developed wound infections or blood clots. Pain in the scar was reported by four people. Unfortunately, one person fell and tore the reconstructed tissue. The most surprising finding was the development of peroneal tendinitis (muscle in the lower leg). The authors were unsure how to explain that particular result. Perhaps there was more general tendinopathy (affecting more than just the Achilles tendon) present before surgery than they realized. Or maybe this was a new problem developing as a result of the surgery. They suggest further study to sort this out in an effort to prevent it from happening. Your surgeon will also go over with you what to expect. That usually includes a list of things that could go wrong with any surgery and in particular, this procedure. If your case goes like the ones reported in the literature, you can expect a slow but steady progress toward improvement and full recovery.