I had surgery to repair an achilles tendon rupture. The skin around the heel and ankle is very tight and around the heel painful to the touch five weeks post surgery. Is that normal? Scar is healing OK.
Unfortunately, it is not uncommon. The skin on the back of the distal leg and heal is separated from the underlying tendon and bone by just a very thin layer of tissue. This tissue is very filmy and spiderweb appearing. It allows the outer layers (skin) to slide on the lower layers of tissue. Anytime it is disrupted with swelling, injury, inflammation, surgery, etc it can become very adhesive.
Thus the skin sticks down to just about everything in the posterior aspect of the distal leg and heel.
Though some of this will resolve with time, usually it is necessary to do some friction massage to help get the planes between the tissues developed again. However, even with the friction massage and physical therapy modalities (ultrasound, iontophoresis, etc) some patients will have some adhesions forever.
As long as the wound is healed well, you can probably start on doing some friction massage yourself. If you are unsure, ask your surgeon or physical therapist. You can also try some silicone sheets over the incision area. Though these are mostly for hyptertrophic scars, it may help to soften the scar like tissue. You can usually get these from a pharmacy and cut them to the size needed. If not, your therapist may have some (occupational therapist usually have them for wound dressing). It is just a sheet of silicone. Plastic surgeons recommend that they be used over scars to prevent hypertrophy of the incision.
If the friction massage is not doing the job, speak with your physical therapist about other things that can be done.
However, if can take many months for the scar to mature and soften. So, you may not know your final outcome for as much as a year or so.
Thanks so much for your prompt response. I have been messaging in circular motions the painful area and it helps. Still a scab or two that have to fall off, so I will try friction message when incision has completely healed. One more questions, please. I am African American and the skin around the incision is now very dark. It that permanent? if so will a skin lightening cream help?
Being dark skinned also sets you up for more extensive scarring. Many blacks form keloids when the skin is cut or damaged. So, you may also have some extra adhesions under the skin, in the subQ tissues. Sorry.
As to the darkness, yes that will lighten up some as the area is less inflamed and the scar tissue matures.
Plastic surgeons recommend that a patient not expose scars to UV light (natural or on a tanning bed) for at least a year. If it is, the scar will "tan" becoming darker than the surrounding tissue permanently.
You do not say when your surgery was done, but if you still have some scabs, it was not all that long ago. So, you are probably still in that stage where inflammation is predominant (inflammation is actually the first stage of healing and is necessary). So, the adhesion of the tissues is probably around its peak state.
Your heel should soften quite a bit as it continues to heal. But, again, you are dark skinned, so, if you have formed keloids in other areas, you may have some problems on the heel also. If you are not a keloid former, then you should be okay.
Thanks so much. You have been very helpful. Had my surgery 1/17/12. Entering my eight week and have been partial weight bearing since the sixth week. Is it unusal that at the end of the day there is no swelling on the right side of the tendon (surgery on left foot), but there is always swelling on the left side between the back of the tendon and the ankle bone? swelling is not above the ankle bone.
Edema (swelling) will track to where ever there is a place for it to go. So, it may be that the lateral side (left side) of the Achilles is less scarred in the subQ tissues, thus there is some room for the edema to collect.
Usually, when the Achilles tendon is operated upon, the skin incision is placed to one side, not directly over the tendon. This is up to the surgeon, but usually, it is placed off to one side, usually the medial (right side on a left ankle). This is so that there is not as much scarring directly over the tendon. This would also allow more room on the lateral side for the swelling to go (less scar tissue on that side). But, again, it is up to the surgeon, as to where the incision is placed.
So, again, it is not uncommon to have swelling at the end of the day, and for it to collect wherever it can find a place to settle.
You might want to obtain one of the neoprene ankle sleeve/supports. These are good at providing compression uniformly around the ankle. You might notice less edema at the end of the day.
Thank you. Wont start rehab with therapist until end of month. had surgery 1/17/12, but ruptured tendon 10/21/11. Tendon had to be reshaped and alot of scar tissue. I asked about going to PT before surgery, but doc had me from night after surgery flexing and pointing toes as often as possible every day. Also very slight with gradual increasing ankle rotation at home and each week when boot was adjusted, and tendon stretched, and alot massage at home. After three weeks started drawing alphabet in air with big toe. Worked really well. Very good dorsal and plantar flexion. But I guess the really hard work starts with the PT. Does it really take six weeks to get the muscle back in my calf? Will it take more time because of my age, 55? Oh, you were right. Skin around ankle is getting better. Still sensitive to touch but Coconut oil helped really well with the tightness.