Achilles Tendon Rupture

WHAT IS AN ACHILLES TENDON TEAR?

The Achilles tendon is a large tendon at the back of the lower leg and ankle that connects the calf muscles to the heel. It is the largest tendon in the body.

An Achilles tendon tear, or rupture, results in a gap between the upper and lower portions of this tendon. It most often occurs 2-3 inches above the heel bone but can be directly at the attachment or higher in the leg.

Symptoms

A tear usually occurs during activities such as running and jumping, or trauma such as a slip and fall. Most patients report their first feeling was a "pop" or like they were struck in the back of the ankle, followed by some pain. After the tear, patients complain of weakness when pushing off of their foot during walking or when trying to stand on tiptoe. There may be a small bruise on the inside of the heel during the first few days.

Diagnosis

Your foot and ankle orthopaedic surgeon performs an examination to make a diagnosis. You will lie in a facedown position with your ankles off the edge of the exam table. When the Achilles tendon is not torn, it is taut and the ankle lies in a toe down position of approximately 20 degrees. Squeezing the upper calf will cause the toes to point down even further.

If the tendon is torn, it does not have this tension and the ankle usually will hang at about a 90-degree angle. Squeezing the upper calf will cause weak or no movement. Your surgeon will lightly pinch the Achilles tendon 2-3 inches above the heel to determine if there is a gap. Special tests such as ultrasound, X-rays, and MRI scans typically are not helpful but can be in some instances.

Treatments

Both non-surgical and surgical treatments have been well studied but remain debated. At one year, both treatments result in great results.

In general, surgical treatment is thought to give greater strength and result in a lower risk of repeat tear. However, surgery has an increased risk of wound healing problems, nerve damage, and infection plus the usual risks associated with surgery. Blood clots are a concern with both types of treatment.

Non-surgical Treatment

Immediate weight bearing with heel wedges in a CAM boot.  At four weeks, the heel wedges are removed every few days. ROM exercises at this point and physical therapy is started. Usually, people are riding a stationary bike and walking without the boot at 6 weeks.

Surgical Treatment

In this surgery, your foot and ankle orthopaedic surgeon will place stitches into the tendon above and below the area of the tear and then pull the ends together. This is because the actual tear appears similar to two wet mops with multiple uneven strands that need to be brought together. The stitches can be applied through one or more incisions (viewing the tendon directly) or through multiple small incisions (placing the sutures through the tendon using a guide). The recovery after surgery is longer than non-surgical treatment. Patients cannot walk on their repair for four weeks, then weight bearing is started in a boot along with physical therapy.

Risks and Complications

All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.

Potential complications specific to Achilles tendon surgery include wound infection and delayed wound healing. Re-rupture can also occur. There may be scarring of the tendon or thickening of the surgical scar. A nerve that gives sensation to the outside part of the foot can be stretched or injured during surgery, which can result in numbness or burning.

Recovery

IT WILL TAKE ONE YEAR

Since tendons do not have a great blood supply, healing is a slow process. Patients usually can start light jogging in 3-6 months with return to sports involving cutting and jumping in 6-9 months. Full return of strength and the feeling of being normal may take more than a year.

PROS AND CONS OF TREATMENT

Non-operative

Surgery

Other Foot & Ankle Conditions