Achilles Tendon Rupture

Many people feel like they have sustained a blow to bottom of their calf from behind. This may be accompanied by a loud snap and difficulty weight bearing.

The tendon most frequently ruptures spontaneously in the middle aged athlete, men more so than women. Eccentric loading or inconsistent training may contribute. Some people have had prodromal symptoms before they rupture their Achilles.

• Weight-bearing X-rays are required
• Ultrasound scans and MRIs may be required

Management is based upon the patient’s age, chronicity of the lesion, location of the rupture, skin quality, associated injuries, and other medical comorbidities.

If diagnosed within 48-72 hours of injury and treated appropriately, an early functional rehabilitation program may be prescribed as treatment.

• Pain medications e.g. NSAIDS such as Mobic or Panadol Osteo
• Accelerated functional rehabilitation for both non-surgical and surgically managed achilles rupture:
  • 0-2 weeks: NWB with 4 wedges in boot
  • 2-4 weeks: PWB-WBAT with 4 wedges (2cm) in boot. ROM exercises below neutral
  • 4-6 weeks: WBAT with 3 wedges in boot. NWB cardio fitness in boot. ROM exercises below neutral
  • 6-8 weeks: WBAT in boot. Remove 1 wedge each week. Controlled progressive stretching of the achilles beyond neutral may begin with supervision
  • 8 weeks: wean boot. Gait retraining. Strengthening
  • 12 weeks: single calf raises, strengthening then sport specific training
  • 6 months: eccentric loading. Gradual return to low impact activities
  • 9 months: return to high impact activities e.g. soccer, football, if single heel raise can be demonstrated

There remains ongoing discussion within the medical literature regarding the potential increased risk of rerupture in non-operatively managed patients balanced with the risk of complications with surgery.

Surgical repair of an Achilles tendon is best performed within a week of the intiital rupture. If the Achilles has ruptured from the bony insertion point, surgery will be recommended. Options include:

• Open Achilles tendon repair
• Minimally-invasive repair
• Augmented repair with an extra tendon

Chronic ruptures: there are a number of different options including reconstruction and shortening procedures. It is important to remember your Achilles tendon is vulnerable to rerupture during your recovery period for both surgical and non-surgical management. It is important to comply with the protocol to reduce this risk and to avoid sudden accelerating movements that may occur during your every day activities such as climbing stairs.

All surgery has risks involved, however every effort is made to reduce these risks. Risks include but are not limited to:

• Infection: superficial wounds or deep infections
• Clots: DVT (deep venous thrombosis) or PE (pulmonary embolus)
• Nerve damage: tingling, numbness or burning
• Ongoing pain
• Stiffness of the ankle joint
• General or anaesthetic risks including to the heart and lung
• Drug reactions/allergy
• Scarring or tethering of the skin
• Rerupture
• Calf weakness
• Revision surgery

There are increased risks of surgery in diabetics, smokers, significant peripheral vascular disease, severe neuropathy, previous or current infection which may preclude a patient from surgery.

View FootForward for Diabetes (run by Diabetes Australia) for more information on foot care.