Have I Suffered A Ruptured Achilles Tendon?

Overview

Achilles Tendonitis

Achilles Tendon Rupture Surgery is a surgical procedure is used to repair a ruptured Achilles tendon. There are two types of surgery an open surgery and a percutaneous surgery, in both cases the surgeon sews the tendon back together through the incision helping the tendon to heal properly and restore function to the foot and ankle. If the injury or rupture has caused severe swelling the surgery may be delayed for a short period of time to allow the swelling to go down.


Causes

Achilles tendon rupture occurs in people that engage in strenuous activity, who are usually sedentary and have weakened tendons, or in people who have had previous chronic injury to their Achilles tendons. Previous injury to the tendon can be caused by overuse, improper stretching habits, worn-out or improperly fitting shoes, or poor biomechanics (flat-feet). The risk of tendon rupture is also increased with the use of quinolone antibiotics (e.g. ciprofloxacin, Levaquin).


Symptoms

Symptoms of an Achilles tendon injury are as follows. Pain along the back of your foot and above your heel, especially when stretching your ankle or standing on your toes; with tendinitis, pain may be mild and worsen gradually. If you rupture the tendon, pain can be abrupt and severe. Tenderness. Swelling. Stiffness. Hearing a snapping or popping noise during the injury. Difficulty flexing your foot or pointing your toes (in complete tears of the tendon).


Diagnosis

The diagnosis of an Achilles tendon rupture is made entirely on physical examination. Often, there is a substantial defect in the Achilles from 2-5 cm before it inserts into the heel bone. However, the main test is to determine whether the Achilles has been ruptured is the Thompson test. This essentially involves placing the patient on their stomach and squeezing the calf muscle. If the Achilles is intact, the foot will rise [plantar flex]. If it is ruptured, the foot will not move and will tend to be in a lower lying position.


Non Surgical Treatment

Non-operative treatment consists of placing the foot in a downward position [equinus] and providing relative immobilization of the foot in this position until the Achilles has healed. This typically involves some type of stable bracing or relative immobilization for 6 weeks, often with limited or no weight bearing. The patient can then be transitioned to a boot with a heel lift and then gradually increase their activity level within the boot. It is very important that the status of the Achilles is monitored throughout non-operative treatment. This can be done by examination or via ultrasound. If there is evidence of gapping or non-healing, surgery may need to be considered. Formal protocols have been developed to help optimize non-operative treatments and excellent results have been reported with these protocols. The focus of these treatments is to ensure that the Achilles rupture is in continuity and is healing in a satisfactory manner. The primary advantage of non-operative treatment is that without an incision in this area, there are no problems with wound healing or infection. Wound infection following Achilles tendon surgery can be a devastating complication and therefore, for many patients, non-operative treatment should be contemplated. The main disadvantage of non-operative treatment is that the recovery is probably slower. On average, the main checkpoints of recovery occur 3-4 weeks quicker with operative treatment than with non-operative treatment. In addition, the re-rupture rate appears to be higher with some non-operative treatments. Re-rupture typically occurs 8-18 months after the original injury.

Achilles Tendinitis


Surgical Treatment

Surgery is recommended to those who are young to middle-aged and active. The ruptured tendon is sewn together during surgery. This is an outpatient procedure. Afterward the leg is put into a splint cast or walking boot. Physical therapy will be recommended. In about 4 to 6 months, healing is nearly complete. However, it can take up to a year to return to sports fully.


Prevention

To reduce your chance of developing Achilles tendon problems, follow the following tips. Stretch and strengthen calf muscles. Stretch your calf to the point at which you feel a noticeable pull but not pain. Don’t bounce during a stretch. Calf-strengthening exercises can also help the muscle and tendon absorb more force and prevent injury. Vary your exercises. Alternate high-impact sports, such as running, with low-impact sports, such as walking, biking or swimming. Avoid activities that place excessive stress on your Achilles tendons, such as hill running and jumping activities. Choose running surfaces carefully. Avoid or limit running on hard or slippery surfaces. Dress properly for cold-weather training and wear well-fitting athletic shoes with proper cushioning in the heels. Increase training intensity slowly. Achilles tendon injuries commonly occur after abruptly increasing training intensity. Increase the distance, duration and frequency of your training by no more than 10 percent each week.

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