An Achilles Tendon Rupture is a traumatic event that needs appropriate treatment by your physician. The rupture can either be partial or complete depending on the severity. A thorough evaluation needs to be made to differentiate a tendonitis from a rupture and to evaluate the extent of the rupture.
The tendon usually ruptures without any warning. It is most common in men between the ages of 40-50, who play sports intermittently, such as badminton and squash. There was probably some degeneration in the tendon before the rupture which may or may not have been causing symptoms.
Symptoms of an Achilles tendon rupture include sensation that someone or something has hit the back of the calf muscle, sudden pain, pain when walking, weakness in the leg, which is particularly noticeable when trying to push off while walking and there is not sufficient strength to do so.
Your doctor will ask you about your symptoms and examine you. He or she may also ask you about your medical history. Your doctor may ask you to do a series of movements or exercises to see how well you can move your lower leg. He or she may also examine your leg, heel and ankle and may squeeze your calf muscle to check the movement of your foot. You may need to have further tests to confirm if your tendon is torn, which may include the following. An ultrasound scan. This uses sound waves to produce an image of the inside of your leg. An MRI scan. This uses magnets and radio waves to produce images of the inside of your leg.
Non Surgical Treatment
There are two treatment options available which are non-operative and operative. Non-operative treatment involves the use initially of a below-knee plaster with the foot held fully bent downwards. This usually stays in place for 2 weeks then is changed for a brace(this is a boot from the knee down to the toes with Velcro straps) which should be worn day and night. The brace will be regularly altered to allow the foot to come up to a more neutral position. The brace will be on for a further 6 weeks. After the 8 weeks you will be referred for physiotherapy to regain movement and calf strength but will probably need to wear the brace during the day for a further 4 weeks. Non-operative treatment avoids the risks of surgery but the risk of the tendon re-rupturing, which normally occurs within 3 months of discarding the brace, is 10%.
Surgical techniques for rupture repair are varied but usually involve reapproximation of the torn ends of the Achilles tendon, sometimes reinforced by the gastrocsoleus aponeurosis or plantaris tendon. Open reconstruction is undertaken using a medial longitudinal approach. Studies indicate that patients who undergo percutaneous, rather than an open, Achilles tendon rupture repair have a minimal rate of infection but a high rate of sural nerve entrapment (16.7% of treated cases).
The best treatment of Achilles tendonitis is prevention. Stretching the Achilles tendon before exercise, even at the start of the day, will help to maintain ankle flexibility. Problems with foot mechanics can also lead to Achilles tendonitis. This can often be treated with devices inserted into the shoes such as heel cups, arch supports, and custom orthotics.