Achilles Tendon Anatomy
Tendons are the soft tissues connecting muscle 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 muscles tightens the Achilles tendon and pulls the heel, enabling the foot and toe movements necessary for walking, running and jumping.
Achilles Tendon Injury
The Achilles tendon is often injured during sports activities, resulting in an inflammatory condition called tendonitis, which is characterized by swelling and pain. In some cases, severe injury results in a tear or rupture of the Achilles tendon, requiring immediate medical attention.
Causes of Achilles Tendon Injury
The tear or rupture of the Achilles tendon is commonly seen in middle-aged men involved in sports activities. The tendon ruptures as a result of weakness due to advanced age or from sudden bursts of activity during certain sports such as tennis, badminton, and basketball. Having a history of tendonitis can make you more susceptible to ruptures.
Symptoms of Achilles Tendon Injury
The classic symptom of an Achilles tendon rupture is pain in the posterior ankle with weakness when trying to ambulate and push off your toes. You may often experience a “popping” or “snapping” sensation with severe pain, swelling, and weakness in the posterior ankle region, followed by bruising of the area.
Diagnosis of Achilles Tendon Injury
Dr. Richardson can typically diagnosis a ruptured Achilles tendon based on your symptoms, history of the injury, and by performing a thorough physical examination. Sometimes higher-level imaging such as an MRI of the ankle is required but not always. The physical examination performed typically consists of feeling for the presence of a gap or depression in the tendon, just above the heel bone. Dr. Richardson will typically gently squeeze the calf muscles to perform the Thompson test. If the Achilles tendon is intact, there will be flexion movement of the foot, if it is ruptured, there will be no movement observed.
Treatment of Achilles Tendon Injury
An Achilles tendon rupture is treated using non-surgical methods or surgery. Non-surgical treatment involves initially wearing a splint or special Controlled Ankle Motion (CAM) boot that lifts your heel and allows the tendon to heal. Then a standard functional Achilles rehab program is started within 1-2 weeks of the injury with early weightbearing following a strict protocol. Compliance with physical therapy and the functional rehab protocol is critical for a good outcome with either non-operative or operative care.
Indications for Achilles Tendon Repair
Surgery may be recommended especially for competitive athletes, those who perform physical work, failure of conservative measures, or in instances where the tendon re-ruptures.
Surgery is typically contraindicated if you have unhealthy skin, an active infection, uncontrolled diabetic, active smoking/nicotine use and are unable to comply with the requirements of postoperative recovery.
Achilles Tendon Repair Procedure
The surgery is usually performed as an outpatient procedure, under a nerve block and sedation. An incision is made at the back of your leg. Your surgeon will stitch the torn tendon back together with strong sutures. 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.
Postoperative Care following Achilles Tendon Repair
Following surgery, your leg will be placed in a cast or splint from your toes to just below your knee. You will be advised not to bear weight on your operated foot and will be prescribed crutches or a walker to help you move around. You will be prescribed a boot or cast after about 2 to 6 weeks, following which you will be allowed to bear your full weight on your leg. You will be advised physical therapy to regain strength and movement in your ankle and calf muscles. You will be able to regain full movement by 6 months and complete recovery in a year.
Complications of Achilles Tendon Repair
As with all surgical procedures, Achilles tendon repair may be associated with certain complications such as infection, bleeding, damage to surrounding structures such as nerve injury, wound healing problems, blood clots, ruptures of the Achilles tendon, and weakness in the foot or ankle when ambulating.
Other Foot & Ankle Procedures
