There are a number of tendon repairs and reconstruction procedures.
Number one is achilles tendon or tendonitis and then it becomes inflamed over a period of time. We usually start by resting the tendon, relaxing it with some type of bracing whether that’s a soft or elastic brace to decrease the demands on the tendon.
We can either immobilize it and then put it in a boot to accomplish the reduction of motion to reduce the stresses and strain mainly on the tendon that will exacerbate or worsen the inflammatory process.
If the inflammation becomes chronic and it’s very painful and if these other non-surgical procedures don’t work – icing and immobilization and so forth – then we can repair the tendon at the most basic and minimal repair.
It requires just removing some of the inflamed scar tissue around the tendon and repairing the tendon primarily and sewing it back together after these tears are corrected and the damaged tendon is removed.
Sometimes if the damage is so severe we are required to apply some type of graft around the tendon to support or stabilize the repair of that tendon.
Sometimes in some cases the tendon is so damaged that we have to take adjacent tendons that aren’t damaged and use those tendons as grafts to support the repair of the damaged tendon.
Sometimes, if the tendon is chronically damaged and so severe and the foot position has caused this then we have to position bones around the tendon or to which the tendons are attached as well as to one of those levels of repair.
How do you fix a torn tendon?
We repair and remove the scar tendon.
Sometimes we can use certain modalities such as laser to repair tendon defects and tears. There is a certain heat therapy that we can use to repair tendons and incite healing by applying a heat device such as infrared to that tendon during surgery to induce the natural repair process to induce blood flow to the damaged area of the tendon.
The next level is removing the damaged tendon and then sewing the damaged tendon back together without a graft.
There are other times that the defect is so significant and severe that we will apply a synthetic or a non-synthetic graft on the tendon to support and reinforce the repair of the tendon.
Do tendon tears heal on their own?
Yes, tendon tears can heal on their own.
The body has an inflammatory process the tendon will go through and sometimes develop scar tissue around that damaged tendon. If the tear is minimal and not complete, then that scar tissue will suffice in the repair of that tendon.
If the tear is complete and the tendon fibers are too far separated at a higher level or a greater distance the repair might not be adequate for future function and the tendon will heal with that scar tissue in a position that is too lengthened and therefore the function of the tendon will be compromised and so augmentation of the tendon and shortening of the tendon to put it in a better position is required.
How long does it take to repair a tendon?
The surgery can be 30 minutes to 1 hour or even 2 hours in some cases.
The recovery usually if we repair a tendon we immobilize it for 4-6 weeks to reduce the strain on the tendon and allow for the tendon fibers to repair before strain is applied to the tendon.
So you can start walking 4-6 weeks after and putting weight on your foot.
How long does it take a tendon to heal?
Repairs normally take about 4-6 weeks before you can put strain on the tendon.
When you get to that 4-6 weeks then you can start applying strain to the tendon in a protected situation.
After 8-10 weeks then the person can usually start ambulating without protection at a low level in comfortable shoes or athletic shoe wear.
Do tendons grow back stronger?
No, usually tendons when they repair they repair with scar tissue.
And ligaments are the same way and the connective tissue of which the tendon is made usually doesn’t allow for a stronger reconstruction of that tendon.
Also within that scar tissue the tendons in that area is compromised and is not as adequate as the original may have been. And therefore the nutrients and replenishment of the tendons … the entire construct of the tendon is not as strong as the original.
And in cases where the tendon is completely torn often we have to apply a graft to augment the repair because of the tear.
How do you know if you ripped a tendon?
Usually the number one sign is a loss of function so the tendon doesn’t … whatever function that the tendon is required for will be weakened.
So a lack of ability to perform a certain motion and often times performing that motion is not painful, you just can’t do it.
For example, for achilles tendon issues most people feel like they’ve been kicked in the back of the leg and they don’t have a lot of pain and they see some swelling but they realize when they try to walk they just can’t walk.
So it’s not the pain that startles them, it’s the inability to function like the inability to walk or move their foot in a certain direction – they just can’t do it because the tendon is not attached.
What other types of problems are there besides achilles tendon?
There’s many tendons in the foot so whatever tendons that are damaged that require repair. The achilles is the strongest and largest tendon attached to the foot so that’s the one that is most significantly damaged and will require long term treatment or surgery to repair it to regain close to or normal function of the foot.
You have posterior tibial tendon which is a very important tendon for the propulsion of the foot – the propulsion strength and ambulation of the foot.
You also have the peroneal (peroneus longus) tendons which also balance and stabilize the foot and ankle and help people maintain their balance and ambulation and keeps the foot in a rectus or straight position as the person walks and to protect them from sprains.
So these tendons are very significant and if damaged often times need repair surgically.