Achilles Tendon Tear/Repair
Tendons are soft tissues connecting muscles to bone. The Achilles tendon is the longest tendon in the body and is present behind the ankle, joining the calf muscles with the heel bone. Contraction of the calf muscle tightens the Achilles tendon and pulls the heel, enabling foot and toe movements necessary for walking, running and jumping.
The achilles tendon is often injured during sports resulting in swelling and pain, a condition called tendonitis. In some cases, severe injury results in a tear or rupture of the Achilles tendon requiring immediate medical attention.
The tear or rupture of the Achilles tendon is commonly seen in middle aged male, weekend athletes with weak tendons due to advanced age and from sudden bursts of activity during sports such as tennis, badminton, and basketball. People with a history of tendonitis are more susceptible for ruptures as well as those suffering from certain diseases such as arthritis and diabetes, or taking certain antibiotics.
The classic symptom of an Achilles tendon rupture is the inability to rise up on your toes. Patients often describe a “popping” or “snapping” sound with severe pain, swelling and stiffness in the ankle region followed by bruising of the area. If the tendon is partially torn and not ruptured, pain and swelling may be mild.
The diagnosis of a torn or ruptured Achilles tendon starts with a physical examination of the affected area, followed by a Thompson test in which the calf muscle is pressed with the patient lying on their stomach to check whether the tendon is still connected to the heel or not.
In certain cases, an ultrasound or MRI scan may be needed for a clear diagnosis.
The main objective of treatment is to restore the normal physiology of the Achilles tendon so the patient can perform activities as before the injury. Immediately following a torn or ruptured Achilles tendon you should employ the RICE method as follows:
Treatment of a torn or ruptured Achilles tendon includes non-surgical or surgical methods. Non-surgical methods involve casting the injured area for six weeks for the ruptured tendon to reattach itself and heal. After removal of the cast, physical therapy is recommended to prevent stiffness and restore lost muscle tone.
Surgery may be recommended especially for competitive athletes, those who perform physical work, or in instances where the tendon re-ruptures. Your surgeon will stitch the torn tendon back together with strong sutures and tie the sutures together. Your surgeon may reinforce the Achilles tendon with other tendons depending on the extent of the tear. If the tendon has avulsed or pulled off the heel bone, your surgeon will reattach the tendon to the heel bone. There are risks associated with any surgery. Specific risks for surgery to repair the Achilles tendon can include infection, bleeding, nerve injury, and blood clots.