Post-Achilles Tendon Repair: Recovery Tips and Concerns

Postoperative condition after Achilles tendon rupture surgery?

Hello Dr.
Wang,
I accidentally ruptured my left Achilles tendon while playing badminton.
Four days after the incident, I underwent a surgical repair and was placed in a cast.
During the first week post-surgery, I returned to the hospital for a dressing change and the surgical site was examined.
There was no bleeding or infection, and the doctor informed me that I could have the stitches removed in the second week.
In the second week post-surgery, the stitches were successfully removed, and the surgical site was healing well.
The doctor advised that I could have the cast removed in the third week.
In the third week post-surgery, the cast was removed, and the doctor informed me that I could only perform rehabilitation stretching exercises on my own, with a follow-up appointment scheduled in three weeks.
Now that I am in the fourth week, I have been doing the stretching exercises on my own.
However, I am encountering some issues: 1.
The area around the wound and my foot has remained swollen since the day of the rupture (there is no pain).
How can I improve this? 2.
The calf muscle on the injured leg is more relaxed compared to the uninjured leg.
3.
The injured foot feels colder than the other one.
4.
How many weeks post-surgery until I can start walking?
Regarding the swelling, the doctor advised elevating my leg post-surgery, but it seems there hasn't been significant improvement.
Are there any other methods to help reduce swelling around the ankle and the surgical incision more quickly, and to facilitate my ability to walk sooner? Thank you for your assistance and response, Dr.
Wang.

Jiarì Yùndòngyuán, 30~39 year old female. Ask Date: 2022/01/25

Dr. Wang Shouji reply Orthopedics

Hello, it is normal for swelling in the lower extremity to persist for two to three months after an Achilles tendon rupture and subsequent casting.
Generally, it takes at least two months to walk normally.
After one month, you may begin partial passive range of motion exercises.
Muscle atrophy in the calf is common, but most patients will see improvement and return to normal activity afterward.
Changhua Hospital cares about your health.
Sincerely, Dr.
Wang Shou-ji.

Reply Date: 2022/01/25

More Info

Post-Achilles tendon repair recovery can be a challenging process, and it's great that you're actively seeking information to aid your recovery. Here are some insights and tips regarding your concerns:
1. Swelling Management: It's common for swelling to persist after surgery, especially in the early stages of recovery. To help reduce swelling, consider the following strategies:
- Elevation: Keep your foot elevated above the level of your heart as much as possible, especially when resting or sleeping. This can help reduce fluid accumulation in the area.

- Ice Therapy: Applying ice packs to the affected area for 15-20 minutes several times a day can help reduce swelling and numb any discomfort. Make sure to wrap the ice pack in a cloth to protect your skin.

- Compression: If advised by your doctor, using a compression bandage can help manage swelling. However, ensure it’s not too tight, as this can impede circulation.

2. Muscle Atrophy: It's normal for the calf muscles on the injured side to feel weaker or more relaxed compared to the uninjured side due to disuse. To address this:
- Gentle Strengthening Exercises: Once cleared by your physician, start with gentle range-of-motion exercises and progress to strengthening exercises as tolerated. Resistance bands can be helpful for gradual strengthening.

- Physical Therapy: If you haven't already, consider working with a physical therapist who can provide a tailored rehabilitation program to strengthen your calf muscles and improve overall function.

3. Cold Sensation: The feeling of coldness in the injured foot can be attributed to reduced circulation or nerve sensitivity post-surgery. To improve circulation:
- Gentle Movement: As you progress in your recovery, gentle ankle pumps and toe wiggles can help stimulate blood flow.

- Warmth: Keeping your foot warm (without overheating) can help improve circulation. Consider wearing a loose sock or using a warm compress (not directly on the incision site).

4. Walking Timeline: The timeline for returning to walking varies based on individual recovery and the specifics of your surgery. Generally, most patients can begin partial weight-bearing activities around 4-6 weeks post-surgery, depending on the surgeon's recommendations. Full weight-bearing may be allowed after 8-12 weeks, but this should be guided by your healthcare provider. Always follow your surgeon's advice regarding when to start walking and any assistive devices (like crutches or a walking boot) you may need.

5. Rehabilitation: Continue with the rehabilitation exercises as advised by your doctor. Consistency is key to recovery. If you feel uncertain about your progress or if swelling persists despite your efforts, don't hesitate to reach out to your healthcare provider for further evaluation.

In summary, managing swelling, addressing muscle atrophy, improving circulation, and following your doctor's guidance on weight-bearing activities are crucial components of your recovery after Achilles tendon repair. Stay proactive in your rehabilitation, and don't hesitate to seek support from healthcare professionals as needed. Your recovery journey may take time, but with patience and diligence, you can achieve a successful outcome.

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