Achilles surgery is reserved for severe, chronic tendinopathy that has not responded to at least 6-12 months of structured conservative treatment. The procedure removes diseased tendon tissue and may include removing a bony prominence (Haglund deformity).
ℹ️ This appointment takes place 2-4 weeks before surgery. Achilles surgery has a prolonged recovery, so good preparation matters.
You will meet the nursing and anaesthetic team. Bloods, ECG, and a full medication review will be carried out. Plan ahead. The early recovery period is restrictive.
Standard pre-operative checks to ensure you are fit for anaesthesia.
Blood thinners may need to be paused. Quinolone antibiotics should be avoided around the time of surgery.
Usually performed under general anaesthesia with a popliteal nerve block for post-operative pain relief lasting 12-24 hours.
You will be non-weight-bearing or partial weight-bearing for several weeks. Set up a downstairs sleeping area if needed and arrange help for the first 1-2 weeks.
Smoking significantly impairs tendon healing. Stop smoking at least 4 weeks before surgery if at all possible.
ℹ️ You will be given a specific arrival time. Do not eat or drink (other than clear water up to 2 hours before) from midnight the night before. Bring your medication list and any documents sent by the hospital.
You will be admitted to the ward or day surgery unit, change into a gown, and be seen by the nursing, anaesthetic, and surgical teams before theatre.
Your surgeon will confirm the procedure, mark the operative side, and you will sign a consent form before going to theatre.
You will meet the anaesthetist in the anaesthetic room. Once anaesthesia is established, the procedure will begin.
After surgery you will wake in the recovery room where nurses monitor your vital signs until you are stable and comfortable.
Most foot and ankle surgery is performed as a day case, meaning you go home the same day. More complex procedures such as ankle replacement or flat foot reconstruction usually require 1-3 nights in hospital. Before discharge, the team will check your pain is controlled, give you wound care instructions, and confirm your follow-up appointment.
You will be given oral pain relief before discharge. Take it regularly for the first 48 hours rather than waiting until pain is severe.
A nurse will check the wound before you leave and explain how to keep it clean and dry.
You will be shown how to use crutches and given clear instructions about weight-bearing on your operated foot.
You will receive a letter for your GP and details of your next outpatient appointment, usually at 2 weeks for a wound check.
Arrange for a family member or friend to collect you. You must not drive after a general anaesthetic or sedation.
⚠️ Important: Wound healing is a major concern after Achilles surgery, the skin over the tendon has a poor blood supply. Report any redness, discharge, or increasing pain urgently. Do not remove your boot or weight-bear against advice.
Keep the foot elevated above the level of your heart for as much of the day as possible during the first 2 weeks. This significantly reduces swelling and helps healing.
Avoid getting the wound wet until it is fully healed, usually 10-14 days. Use a waterproof cover when showering.
Do not wait until pain is severe before taking medication. Regular simple analgesia (paracetamol, ibuprofen if appropriate) is more effective than taking it only when needed.
This is usually 2 weeks after surgery. Sutures or clips will be removed if used.
Seek urgent advice if you develop increasing redness, warmth, swelling, discharge from the wound, calf pain or swelling (possible DVT), shortness of breath, or a temperature above 38°C.
Foot held in a slight pointing-down position to protect the tendon. Crutches required.
Progressive removal of heel wedges as the tendon heals. Gradually increasing weight-bearing.
Transition to normal shoes. Structured calf stretching and strengthening programme begins.
Walking comfortably, return to work and most daily activities.
Full recovery and return to high-impact activity, guided by your physiotherapy team.
Most surgeons use a walking boot with adjustable heel wedges rather than a plaster cast. The boot is worn for around 6 weeks.
You cannot drive while in the boot. Return to driving is typically around 8-10 weeks for the right foot, sooner for the left if you have an automatic car.
Desk work: 2-4 weeks. Standing work: 8-12 weeks. Heavy manual work: 4-6 months.
Around 75-85% of patients have a good outcome. Recovery is slow but typically progressive over 6-12 months.
Plain-English answers to the things people most often ask, grounded in published guidance. Tap a question to open it.
Diseased tendon tissue is removed and, where needed, the calf is lengthened (gastrocnemius recession) or the tendon reinforced with a transfer for larger areas of damage.
The exact procedure depends on where and how worn the tendon is.
Only after at least six months of a good non-surgical loading programme has failed to settle symptoms.
Most people with Achilles tendinopathy never need surgery.
Usually a general or spinal anaesthetic, often with a nerve block for pain relief.
This is discussed with your anaesthetist beforehand.
A boot is usual, followed by progressive rehabilitation over several months. A tendon transfer recovers more slowly.
Patience with rehab gives the best result.
Arrange crutches, help at home, and time off work, and set up somewhere to keep the leg elevated.
Plan for limited mobility in the early weeks.
Spreading wound redness, discharge or a temperature can signal infection, and calf or chest symptoms can signal a clot.
Both need prompt help.