Corrective surgery for Achilles tendonitis and spurs or a Haglund’s deformity on the back of the heel is considered when all reasonable conservative measures have failed to provide tissue healing and pain relief. An incision is made on the back of the heel, usually to one side of the Achilles tendon or the other. The Achilles tendon is then exposed, and any damage to the tissue is repaired by either removing unhealthy tissue or calcified tissue, or sewing any tears in the tendon. If a heel spur is present, the tendon may or may not have to be removed from the heel bone. If the spurs are higher than the tendon attachment, the bone can be shaved down without having to disrupt the attachment of the tendon. This is also usually the case when shaving down a Haglund’s deformity. If the spur is directly behind the Achilles attachment, then the tendon will have to be released form the bone. The spur is then shaved down completely, and the tendon is reattached using a tendon anchor buried into the heel bone.
If the Achilles tendon is particularly frayed or weakened, a graft may be used to strengthen it. This graft can be a pre-made biological product, or it may be obtained from other less necessary soft tissue in one’s own body.
Recovery can vary depending on whether the Achilles tendon was removed from the heel bone. If it was not removed, once the procedure is completed the foot is protected in a sterile dressing and is supported in a walking boot to prevent strain to the Achilles attachment. Most people are able to regain full activity within four to six weeks. If the Achilles tendon was removed, the leg is given a fiberglass cast below the knee to lock the ankle into position and prevent the Achilles tendon from tearing off of the heel bone. This is done for four weeks while the tendon reattaches to bone, after which the foot is protected in a walking boot to prevent undue strain. Slow activity and normal shoes can be regained approximately four weeks after that. From there onward the Achilles tendon slowly strengthens over the next several months, although most people can resume full activity in a shorter period of time.