Achilles Tendon Rupture
An Achilles tendon rupture is an injury which is typically sustained by people who play sports but can happen to anyone. It affects the back of the lower leg.
The Achilles tendon is the fibrous cord which connects the heel bone with the muscles in the back of the calf. It is vital for walking because it allows you to push your foot off and rise on your toes. An Achilles tendon rupture happens when the Achilles tendon is overstretched.
An Achilles tendon rupture - which normally happens in the tendon section that is located within around six centimetres of where it attaches to the heel bone - typically happens due to excess tension on the Achilles tendon. This can occur when; falling from a significant height, falling into a hole, sports which involve jumping, sudden sprinting and increasing the intensity of a sport or exercise.
There are risk factors which may increase the chance of an Achilles tendon rupture happening, such as; being aged between 40 and 60, taking part in certain recreational sports - such as basketball, tennis and football - which can require a lot of running and jumping.
In some cases, you may experience no symptoms after an Achilles tendon rupture. But most people will experience symptoms such as; a snapping sensation, a popping sound when the rupture happens; pain, which can range from mild to severe; swelling near the heel; the sensation of having been 'kicked in the calf; the inability to stand on your toes on the affected leg; and the inability to push off from the injured leg when you walk.
If you hear the popping sound or snapping sensation described above following an injury, and have trouble walking, seek immediate medical advice.
Your doctor will examine your foot and will check for the signs of flat feet or high arches, tenderness, swelling and redness of the foot and stiffness or tightness of the arch in the bottom of your foot.
An Achilles tendon rupture will normally be diagnosed using a physical examination initially which will allow your doctor to check for swelling and tenderness, as well as feel for the 'gap' created by a complete tendon rupture. You may be asked to sit or lie in certain positions and perform certain exercises. An ultrasound or MRI scan may be ordered to aid diagnosis if necessary.
The treatment path which is chosen for an Achilles tendon rupture will depend on factors such as activity level prior to injury, general state of health and the presence of other medical conditions. Non-surgical options include the use of an equinus cast or boot which can prevent the ankle from moving in the aftermath of the injury. Weight bearing can commence once the foot is secured in a downward pointing direction. This helps the two ends of the Achilles tendon to join together to allow healing. Sometimes the Achilles tendon can heal in an elongated position if it is allowed to stretch out or if the foot is not placed in the correct position very soon after injury.
In some cases, surgery can be seen as the best course of action after an Achilles tendon rupture, as it can speed up recovery and reduce the chance of a re-rupture. The procedure itself will normally involve an incision in the lower leg before the tendon is sutured together. A significant benefit of surgical treatment is to secure the two ends of the tendon together so that they heal at the correct length. If the tendon heals too long, then calf muscle strength will be permanently compromised.
At Sussex Foot & Ankle Clinic Mr Ajis uses a minimally invasive Speedbridge technique. This does not rely on suture knots to hold strands of tendon together but instead strengthens and reinforces the core of the tendon and connects the calf muscle directly to the heel bone.
This can be done through a small incision a couple centimetres long. Recovery involves 2 weeks in a temporary plaster cast followed by a vacoped boot for 7-9 weeks. Once the Achilles tendon heals, the calf muscle, which quickly atrophies, can then be retrained and strengthened. This process can take many months and will involve a great deal of hard work and perseverance.
As with all foot surgery it is normal for swelling to persist for some months after surgery and is completely normal. This swelling will eventually completely subside with time and can take up to 12 months but often goes well before this.