Achilles tendon debridement is an operation to remove damaged, degenerate tissue from the Achilles tendon (insertional or midsubstance tendinopathy) that has not responded to non-operative treatment.
An incision is made along the tendon. The degenerate, thickened portion of the tendon is identified and carefully excised. If more than 50% of the tendon width is removed, the repair may be augmented with a tendon transfer (typically the flexor hallucis longus). For insertional disease, a prominent bone spur (Haglund's deformity) may be removed at the same time. The operation takes one to one and a half hours.
Surgery is considered for chronic Achilles tendinopathy causing persistent pain that has not improved after at least six months of physiotherapy (eccentric exercises), shockwave therapy, and other non-operative treatments.
Eccentric exercise programme (Alfredson protocol), shockwave therapy, activity modification, heel raises, appropriate footwear, and PRP injection. Most patients improve without surgery.
MRI or ultrasound to assess the tendon. Standard pre-assessment.
Pain relief and improved function in approximately 75-85% of patients. Recovery is gradual.
Full recovery takes six to twelve months.
The Achilles area has relatively poor blood supply.
Not all patients achieve complete pain relief.
If significant tendon is removed, the weakened tendon may rupture.
Numbness on the outer foot.
Particularly in smokers.
Wound infection.
General or regional anaesthesia with ankle block.
Walking boot for four to six weeks. Progressive weight-bearing. Physiotherapy for calf strengthening from six weeks. Running at three to four months. Full recovery six to twelve months.
Reviews at two weeks, six weeks, and three months.
Tendon tissue heals slowly due to its limited blood supply. Gradual loading is essential to allow the tendon to remodel.