Achilles Tendon Rupture

Anatomy

The Achilles tendon is a strong, fibrous band that connects the calf muscle to the heel. The calf is actually formed by two muscles, the underlying soleus and the thick outer gastrocnemius. Together, they form the gastroc-soleus muscle group. When they contract, they pull on the Achilles tendon, causing your foot to point down, allowing you to rise up on your toes. This powerful muscle group helps when you sprint, jump, or climb.

Causes

Achilles tendon ruptures are most commonly seen amongst weekend warriors between the age of 30-50. Pre-existing inflammation and degeneration of the tendon that may or may not have been symptomatic is thought to be the cause of rupture.

Symptoms

An Achilles tendon rupture is usually an unmistakable event. Some bystanders may report actually hearing the snap, and the victim of a rupture usually describes a sensation similar to being violently kicked in the calf. Following rupture the calf may swell, and the injured person usually can't rise on his toes.

The classic example is a middle-aged tennis player or weekend warrior who places too much stress on the tendon and experiences a tearing of the tendon. In some instances, the rupture may be preceded by a period of tendonitis, which renders the tendon weaker than normal.

Nonsurgical Treatment

Nonsurgical treatment for an Achilles tendon rupture is somewhat controversial. It is clear that treatment with a cast will allow the vast majority of tendon ruptures to heal, but the incidence of rerupture is increased in those patients treated with casting for eight weeks when compared with those undergoing surgery. In addition, the strength of the healed tendon is significantly less in patients who choose cast treatment. For these reasons, many orthopedists feel that Achilles tendon ruptures in younger active patients should be surgically repaired.

Surgery

Surgery may be suggested if you have a ruptured Achilles tendon. Reattaching the two ends of the tendon repairs the torn Achilles tendon. This procedure is usually done through an incision on the back of the ankle near the Achilles tendon. Numerous procedures have been developed to repair the tendon, but most involve sewing the two ends of the tendon together in some fashion. Some repair techniques have been developed to minimize the size of the incision.

In the past, the complications of surgical repair of the Achilles tendon made surgeons think twice before suggesting surgery. The complications arose because the skin where the incision must be made is thin and has a poor blood supply. This can lead to an increase in the chance of the wound not healing and infection setting in. Now that this is better recognized, the complication rate is lower and surgery is recommended more often.

Rehabilitation

Nonsurgical Treatment
Nonsurgical treatment for a ruptured Achilles tendon is handled differently. This approach might be considered for the aging adult who has an inactive lifestyle. Nonsurgical treatment in this case allows the patient to heal while avoiding the potential complications of surgery. The patient is casted for eight weeks. Casting the leg with the foot pointing downward brings the torn ends of the Achilles tendon together and holds them until scar tissue joins the damaged ends. A large heel lift is worn in the shoe for another six to eight weeks after the cast is taken off.

Surgical Treatment
Immobilizing the leg in a cast can cause joint stiffness, muscle wasting (atrophy), and blood clots. To avoid these problems, surgeons may have their patients start doing motion exercises very soon after surgery. Patients wear a splint that can easily be removed to do the exercises throughout the day. Crutches would be needed at first to keep from putting weight onto the foot. Conditioning exercises during this period help patients maintain good general muscle strength and aerobic fitness. Upon removing the splint, a shoe with a fairly high heel is recommended for up to eight more weeks, at which time physical therapy begins.

Therapy
In this early-motion approach, physical therapy starts within the first few days after surgery. Therapy may be needed for four to five months. Ice, massage, and whirlpool treatments may be used at first to control swelling and pain. Massage and ultrasound help heal and strengthen the tendon.

As your symptoms ease and your strength improves, you will be guided through advancing stages of exercise. Athletes begin running, cutting, and jumping drills by the fourth month after surgery. They are usually able to get back to their sport by six full months after surgery.

The goal is to help you keep your pain and swelling under control, improve your range of motion and strength, and ensure you regain a normal walking pattern.