Overview
The Achilles tendon affects your ability to do everything from walking to playing competitive sports. When a patient overstretches his or her Achilles tendon, it can result in a full or partial tear in the tendon, also known as a rupture. In addition to causing a great deal of pain, ruptures can have a profoundly negative impact on your quality of life and prevent you from performing activities you once enjoyed. Because these injuries tend to worsen with time, it?s important to contact a board certified orthopedic surgeon for immediate attention after an Achilles tendon tear.
Causes
Repeated stress from a variety of causes is often the cause of Achilles tendon injury. The stress may occur from any of the following. Excessive activity or overuse. Flat feet. Poorly fitting or inadequate shoes. Inadequate warm-up or proper conditioning. Jogging or running on hard surfaces. Older recreational athlete. Previous Achilles tendon injury (tendonitis/rupture). Repeated steroid injections. Sudden changes in intensity of exercise. Use of fluoroquinolone antibiotics (especially in children). Trauma to the ankle. Tense calf muscles prior to exercise. Weak calf muscles.
Symptoms
Typically patients present with sudden onset of pain and swelling in the achilles region, often accompanied by a audible snap during forceful dorsiflexion of the foot. A classic example is that of an unfit 'weekend warrior' playing squash. If complete a defect may be felt and the patient will have only minimal plantar flexion against resistance.
Diagnosis
A consultation and physical exam with a qualified musculoskeletal expert is the first step. X-ray or MRI scanning may be required for a diagnosis. Once a rupture is diagnosed it should be treated to prevent loss of strength and inadequate healing.
Non Surgical Treatment
Medical therapy for a patient with an Achilles tendon rupture consists of rest, pain control, serial casting, and rehabilitation to maximize function. Ongoing debate surrounds the issue of whether medical or surgical therapy is more appropriate for this injury. Conservative management of Achilles tendinosis and paratenonitis includes the following. Physical therapy. Eccentric exercises are the cornerstone of strengthening treatment, with most patients achieving 60-90% pain relief. Orthotic therapy in Achilles tendinosis consists of the use of heel lifts. Nonsteroidal anti-inflammatory drugs (NSAIDs). Tendinosis tends to be less responsive than paratenonitis to NSAIDs. Steroid injections. Although these provide short-term relief of painful symptoms, there is concern that they can weaken the tendon, leading to rupture. Vessel sclerosis. Platelet-rich plasma injections. Nitric oxide. Shock-wave therapy.
Surgical Treatment
Surgery to repair an Achilles tendon rupture is performed under a spinal or general anaesthetic. During surgery the surgeon makes an incision in the skin over the ruptured portion of the tendon. The tendon ends are located and joined together with strong sutures (stitches), allowing the tendon to closely approximate its previous length. The skin is then closed with sutures and the foot is immobilised in a cast or splint, again in the toes-pointed position. Seven to ten days after surgery the cast or splint is removed in order for the sutures in the skin to be removed. Another cast or splint will be applied and will stay in place a further 5 - 7 weeks.
The Achilles tendon affects your ability to do everything from walking to playing competitive sports. When a patient overstretches his or her Achilles tendon, it can result in a full or partial tear in the tendon, also known as a rupture. In addition to causing a great deal of pain, ruptures can have a profoundly negative impact on your quality of life and prevent you from performing activities you once enjoyed. Because these injuries tend to worsen with time, it?s important to contact a board certified orthopedic surgeon for immediate attention after an Achilles tendon tear.
Causes
Repeated stress from a variety of causes is often the cause of Achilles tendon injury. The stress may occur from any of the following. Excessive activity or overuse. Flat feet. Poorly fitting or inadequate shoes. Inadequate warm-up or proper conditioning. Jogging or running on hard surfaces. Older recreational athlete. Previous Achilles tendon injury (tendonitis/rupture). Repeated steroid injections. Sudden changes in intensity of exercise. Use of fluoroquinolone antibiotics (especially in children). Trauma to the ankle. Tense calf muscles prior to exercise. Weak calf muscles.
Symptoms
Typically patients present with sudden onset of pain and swelling in the achilles region, often accompanied by a audible snap during forceful dorsiflexion of the foot. A classic example is that of an unfit 'weekend warrior' playing squash. If complete a defect may be felt and the patient will have only minimal plantar flexion against resistance.
Diagnosis
A consultation and physical exam with a qualified musculoskeletal expert is the first step. X-ray or MRI scanning may be required for a diagnosis. Once a rupture is diagnosed it should be treated to prevent loss of strength and inadequate healing.
Non Surgical Treatment
Medical therapy for a patient with an Achilles tendon rupture consists of rest, pain control, serial casting, and rehabilitation to maximize function. Ongoing debate surrounds the issue of whether medical or surgical therapy is more appropriate for this injury. Conservative management of Achilles tendinosis and paratenonitis includes the following. Physical therapy. Eccentric exercises are the cornerstone of strengthening treatment, with most patients achieving 60-90% pain relief. Orthotic therapy in Achilles tendinosis consists of the use of heel lifts. Nonsteroidal anti-inflammatory drugs (NSAIDs). Tendinosis tends to be less responsive than paratenonitis to NSAIDs. Steroid injections. Although these provide short-term relief of painful symptoms, there is concern that they can weaken the tendon, leading to rupture. Vessel sclerosis. Platelet-rich plasma injections. Nitric oxide. Shock-wave therapy.
Surgical Treatment
Surgery to repair an Achilles tendon rupture is performed under a spinal or general anaesthetic. During surgery the surgeon makes an incision in the skin over the ruptured portion of the tendon. The tendon ends are located and joined together with strong sutures (stitches), allowing the tendon to closely approximate its previous length. The skin is then closed with sutures and the foot is immobilised in a cast or splint, again in the toes-pointed position. Seven to ten days after surgery the cast or splint is removed in order for the sutures in the skin to be removed. Another cast or splint will be applied and will stay in place a further 5 - 7 weeks.