top of page

Achilles Tendon Reconstruction

Achilles tendon reconstruction is a surgical procedure performed when the Achilles tendon is chronically ruptured, severely degenerated, or has failed previous repair. Unlike an acute rupture, where direct repair is possible, chronic Achilles injuries often have poor-quality tendon tissue that cannot heal properly without additional support.

This procedure is typically needed in patients with:

​

  • Delayed diagnosis of an Achilles rupture (>4–6 weeks old)

  • Re-rupture after previous surgery

  • Severe Achilles tendinopathy (degeneration) leading to tendon rupture

  • Excessive tendon loss due to infection or injury

​​

Studies show that Achilles reconstruction restores function and allows a return to walking and sports, though recovery is longer than standard Achilles repair.

What Does the Surgery Involve?

Achilles reconstruction is more complex than standard Achilles repair. The choice of technique depends on the severity of damage:

 

1. Tendon Transfer Reconstruction (Most Common)

  • A nearby tendon, usually the Flexor Hallucis Longus (FHL) (which helps move the big toe), is transferred to reinforce the Achilles.

  • This provides strong biological support and has excellent long-term success rates.

 

2. Tendon Grafting

  • If the defect is large (>6 cm), a graft may be used from:

    • The patient’s own hamstring or peroneus longus tendon (autograft)

    • A donor tendon (allograft)

 

3. Synthetic or Biological Augmentation

  • In some cases, a biologic scaffold or synthetic mesh is used to reinforce the repair.

 

The procedure is performed under general or regional anesthesia and lasts 60–90 minutes. After surgery, the foot is immobilized in a cast or boot to allow healing.

Alternative Treatments

Non-surgical management is rarely effective for chronic ruptures but may be considered in:

​

  • Low-demand patients who do not require full strength for daily activities.

  • Elderly or high-risk patients where surgery may carry significant risks.

 

Non-operative treatment involves:

  • Bracing with a custom ankle-foot orthosis (AFO) to assist walking.

  • Physiotherapy to improve function, though significant weakness may persist.

 

For active individuals, surgery is usually required to restore strength and function.

Risks and Complications

Achilles reconstruction is a major tendon surgery, and while highly successful, it carries risks:

 

General Surgical Risks:

  • Infection (5–10% risk, higher than standard Achilles repair) – Due to the limited blood supply. May require antibiotics or, in severe cases, additional surgery.

  • Blood Clots (DVT/PE) – Higher risk due to prolonged immobilization. Prevented with blood thinners in high-risk cases.

  • Nerve Injury – The sural nerve, which runs along the Achilles, may be stretched or injured, leading to numbness or tingling.

 

Procedure-Specific Risks:

  • Wound Healing Issues – The Achilles tendon area has a poor blood supply, making wound healing complications more common, especially in smokers and diabetics.

  • Graft Failure or Re-Rupture – While uncommon, a failed reconstruction may require revision surgery.

  • Tendon Weakness or Stiffness – Patients may experience some loss of push-off strength due to the tendon transfer.

  • Calf Muscle Atrophy – Since the Achilles plays a key role in calf muscle function, muscle shrinkage may occur.

  • Reduced Big Toe Strength (in FHL Transfer) – This is usually mild and does not significantly impact walking or sports.

 

Studies show that 80–90% of patients regain good function, but full strength recovery may take 12+ months.

Recovery and Rehabilitation

Time Off Work

  • Desk jobs: 4–6 weeks

  • Manual labor: 12+ weeks

 

Return to Driving

  • 8–10 weeks, depending on weight-bearing status.

 

Return to Activities & Sports

  • Walking unaided: 10–12 weeks

  • Running: 6–9 months

  • Full sports participation: 12–18 months

 

Rehabilitation Timeline

  • Weeks 0–6: Non-weight-bearing in a boot or cast, foot positioned downward.

  • Weeks 6–12: Gradual weight-bearing, range-of-motion exercises.

  • 3–6 months: Strengthening, balance training, and controlled impact activities.

  • 6–12 months: Sport-specific rehab before full return to competitive sports.

 

Most patients regain the ability to walk and perform daily activities well, but full power and explosive strength take longer to return.

bottom of page