Achilles Tendon Rupture
The Achilles Tendon
The Achilles tendon is the strongest and longest tendon in the body. It starts approximately a third of the way up the leg and runs into the back of the heel bone, the tendon is formed from two muscles. The Achilles tendon is a very powerful tendon and is put under increased stress during running and jumping.
Achilles tendon ruptures feel as if you have been kicked at the back of the leg and often a snapping or popping sound may be heard, instability and pain follow this. Ruptures usually occurring during activity and are most common between the ages of thirty and seventy years and occur more commonly in men.
A rupture occurs when the stress placed upon the tendon outweighs its functional capacity. Rarely a fracture of the heel bone can occur where the tendon pulls a section of bone away.
Management of this condition falls into two categories: cast immobilisation and surgical repair. There is still debate over which is the best method. However, surgical repair does allow for a quicker return to activity and a reduced chance of re-rupture.
The foot and leg are placed in a cast with the foot pointed in a downward position. During the first two weeks the foot and leg will be placed in a plaster cast and following on from this a special boot that can gradually increase the amount of motion and position through the ankle. This boot is used over a period of approximately ten weeks, but full recovery can take up to six months.
Surgical repair aims to bring the ruptured ends of the tendon back together. If a surgical repair has been decided upon it is better to perform this sooner rather than later as delaying can lead to contracture of the muscle and lead to an increase in the size of the gap between the ruptured ends that needs to be bridged. A delayed repair often involves more extensive surgery.
The operation is normally performed under general anaesthetic and if possible through a minimally invasive technique. A video of the procedure can be seen by clicking on the link beneath (please be aware the video shows the operation being performed on a cadaver).
If the repair is delayed (longer than one month) and the gap is too large that an end to end repair is not possible without producing a poor position of the foot, procedures to lengthen the tendon to allow for approximation of the ruptured ends is required. This is often supplemented with a tendon transfer to improve the strength at the ankle joint.
Following a surgical repair full weight bearing may be allowed, if not, weight bearing can generally commence at two weeks with the use of a special boot. As well as the boot there will be extensive physiotherapy treatment. The immediate post-operative recovery takes between eight to ten weeks and during this time you will mobilising in the walker boot. Following on from this you will return to a trainer type shoe and can gently and carefully start to increase your activities. Driving a manual car will not be possible during this period but you can drive an automatic car if the right leg has been operated on. A return to full activities, especially sport can take some six to nine months.
As with any surgical procedure there are complications these include general complications and specific complications including: reduced power of the tendon; push off strength / tip toe raises, injury to a nerve running close to the tendon, adhesions between the tendon and the tendon sheath; this is reduced by physiotherapy and patient directed treatment.