Achilles Tendon Rupture
The Achilles tendon is the largest tendon in the body. It joins the calf muscles (gastrocnemius and soleus muscles) to the calcaneus (heel bone) and assists in walking, running, raising the heel and jumping. It is the primary plantar flexor of the foot. Sudden force through the tendon may cause a rupture, resulting in significant weakness of plantar flexion. It is a relatively common injury occurring in high level and “weekend warrior” athletes, most frequently in men aged 30-50 years. These injuries are commonly missed, in up to 25% of cases.
This surgical procedure is used to repair a ruptured achilles tendon, the large tendon that travels down the back of the ankle. This procedure will help the tendon heal properly, restoring function to the foot and ankle.
It 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.
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.
- Natural history:
A delay in treatment may lead to the tendon healing in a lengthened position.
This can cause difficulty walking, with push off (e.g. running), standing on tip-toes or ascending stairs.
Weight-bearing X-rays are required.
MRI or Ultrasound scans 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.
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.
- Non-operative Measures:
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
Considered if treatment has been delayed, but within approximately 10 days of injury.
If the achilles has ruptured from the bony insertion point, surgery will be recommended. Depending on the extent and nature of rupture, surgical options may 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.
Please find more information in the post operative protocol section for your specific surgical procedure.
- Surgery Risks
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
- Calf weakness
- Revision surgery
- Increased risk of surgery in diabetics, smokers, significant peripheral vascular disease, severe neuropathy, previous or current infection which may preclude a patient from surgery
- Post Op Guides
- Ankle Arthrodesis
- Ankle Arthroscopy
- Ankle Fracture
- Calcaneal Fracture
- Flatfoot Reconstruction
- Hallux Rigidus – Arthrodesis
- Hallux Rigidus – Arthroplasty
- Hallux Valgus Surgery
- Lapidus Procedure
- Lateral Ligament Instability
- Midfoot Arthrodesis
- Midfoot Fractures Surgery
- Subtalar Joint Arthrodesis
- Tibiotalocalcaneal Fusion
- Total Ankle Arthroplasty