If you recall, we had discussed Achilles tendonitis/tendinosis in last week’s blog and how this inflammation and weakening of the tendon can lead to complete rupture of the Achilles tendon if not treated properly. However, you do not always have Achilles tendonitis before the rupturing the tendon. The mechanisms for completely rupturing the Achilles tendon, besides having Achilles tendonitis, is having an injury where your foot is forced up (dorsiflexion) while your knee is straight (extended) and a fast with heavy overload when your foot is forced upwards (dorsiflexion).
The people that are most prone to complete Achilles tendon rupture are men who are between the age of 30-50 years old and do not exercise on a regular basis. Patients who fit into this category are commonly referred to as a “weekend warrior.” A weekend warrior is someone who does not regularly play sports and ends up playing too hard for their Achilles tendon to handle, which then leads to rupture.
Signs and symptoms that you have ruptured your Achilles tendon are:
• Extreme pain immediately at the time of rupture
• Patients describe the pain as if someone took a bat and hit the back of their ankle at the Achilles tendon
• Walking with the foot turned outwards and limping
• There is a noticeable gap where the tendon has ruptured; this is called the “hatchet strike defect”
• The ankle and foot is usually extremely swollen
• Unable to point your foot down (plantarflex)
There are several physical examination techniques that can help aid in making the diagnosis, but you will most likely need an MRI to confirm complete rupture of the tendon. In addition, MRI will better show the extent of tendon rupture, where the rupture is located, and help aid in treatment.
A ruptured Achilles tendon may be able to be treated without surgery by wearing a cast for 12 weeks. However, surgical treatment is usually the best treatment for these injuries as it allows for a better and stronger repair of the tendon, which will decrease the chance of future re-rupture. In addition, surgery allows for a faster recovery time and better outcome than the non-surgical cast treatment.
If you are a candidate for surgery and opt to have surgery to repair the Achilles tendon, you will need to wait 7-14 after the injury to have the surgery. This is because this will allow enough time to have adequate blood supply return to the tendon. Blood supply is very important for healing tendons and will help to decrease recovery time.
The way that the tendon is repaired is by making an incision in the back of the ankle where the ruptured tendon ends are located; the frayed ruptured ends of the tendon are made even and then powerful strong suturing techniques are used to literally sew the two ends of the tendon back together. After the tendon is repaired, the skin will be stitched back together; the skin stitches will be able to be removed 2-3 weeks after the surgery. After the surgery you will be wearing an Achilles boot, which goes from your toes to just below your knee. You will not be able to put any weight on the boot for 2-3 weeks. The boot will need to be worn for a total of 6-8 weeks. You will also need to have physical therapy after the surgery to help regain strength and range of motion of the Achilles tendon. You will most likely be able to wear normal gym shoes 12 weeks after the surgery.
Patients who do not seek medical treatment for their Achilles tendon rupture within 14 days of the injury will have a more difficult time healing and delaying surgery often makes for a more difficult procedure, recovery, and poor outcome. If you have injured your Achilles tendon, schedule an appointment for further evaluation and possible surgical treatment at Boulder County Foot and Ankle.
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American Academy of Podiatric Sports Medicine