Achilles Tendon Rupture
Achilles Tendon or heel cord is one of the most powerful tendon which helps to do heel raise when we are walking, running, jumping or standing on tip toe. This tendon is formed by the confluence of calf muscles, which inserts to back of your heel. This is the strongest and thickest tendon in the body and generates lot of forces, which can be several times your body weight during activities.
Most of the patients often describe the sensation of feeling as if someone has kicked or stabbed on the back of the heel. Some patients also describe a popping sensation and can be painful. They can find difficult to walk especially to raise the heel up during walking.
The rupture can happen without any warning. It is most common in men between the ages of 40-50, who play sports intermittently, such as badminton squash or Tennis. There was probably some degeneration in the tendon before the rupture, which may or may not have been causing symptoms. Local steroid injections, Fluroquinolone antibiotics such as Ciprofloxacin and high BMI have also been attributed to high incidence of rupture.
Reaching to a Diagnosis
The history and physical examination findings usually give a straight forward diagnosis of rupture. The doctor might ask you to either lie on your ches in a couch or kneel on a chair to examine the back of your heel for the gap in the tendon and for special test of Achilles tendon rupture. In this position when calf muscles are squeezed the foot moves downwards .A lack of movement on squeezing the calf muscles can be one of the signs of Achilles tendon rupture. In most of the patient gap in the tendon is usually 4-5cm above the heel bone which is called an intra-substance tear. Sometimes the tear can occur higher up about 10cm above the insertion into the heel at the site where the muscles join the tendon, this is known as a musculo-tendinous tear. If the diagnosis is clear we do not need any scans, but when there is doubt of partial rupture or doubtful site of rupture usually we do imaging tests such as ultrasound scan on most of the cases and some times MRI scans on special occasions.
If you believe that you have suffered a ruptured Achilles tendon, you should seek urgent medical advice as the sooner that treatment is started the better the chance of a complete recovery. 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 there is 8% risk of tendon re-rupturing, which normally occurs within 3 months of discarding the brace. Operative treatment involves a 6cm incision along the inner side of the tendon. The torn ends are then strongly stitched together with the correct tension. After the operation a below knee half cast is applied for 2 weeks. At 2 weeks a brace will be applied that will allow you to move the foot and fully weight-bear for a further 6 weeks. After this you will need physiotherapy. The chance of re rupture following surgery is 2-4%, although it carries the general risks of operation. The best form of treatment is controversial with good results being obtained by both methods. Surgery should be considered in the younger and more active patients. Non-operative treatment is generally recommended for less active, older individuals or those with a musculo-tendinous tear (not in the tendon itself). Your surgeon will discuss the options to decide the best form of treatment for you.
Most people are able to return to their previous activity level after prompt treatment. In general the patients are able to return to jogging by 3 months and participate impact sports by 6 months after surgical repair of Achilles tendon.