Achilles Tendon Rupture
The Achilles tendon is the thickest and strongest tendon in the body, joining the calf muscles to the back of the calcaneus (heel bone). As the calf muscles contract, the Achilles tendon is stretched, pulling the heel off the ground. The Achilles tendon is usually approximately 15 cm long and is subjected to great loads, about 6-8 times normal body weight during running.
Achilles tendon rupture refers to a sudden tearing of the tendon, either partial or complete. It is encountered more frequently in adults from 30 to 50 years of age. As we age, the blood supply to our Achilles tendon declines, and hence this injury is more prevalent in older people. Men are more prone to rupture their Achilles tendon, probably because the tendon is not as thick and is subjected to comparatively more stress than in women.
How does the tendon rupture?
Achilles tendon rupture occurs due to a sudden overload or over-the-limit stretching of the tendon.
Age and lack of activity weakens the tendon. Other factors that increase the risk of Achilles tendon rupture include:
The tendon may rupture with an audible sound, a sudden popping, followed by severe debilitating pain in the back of the lower leg, often associated with swelling. One is unable to lift the heel off the ground and walking is severely impaired. The tendon extends from about half-way down the shin to the heel. The area most commonly ruptured is about 2-6 cm above the heel bone, known as the “watershed zone”. This area suffers greater degeneration with age as it lacks good blood supply, which diminishes further as one ages, making it more prone to rupture.
The person is not able to stand on tiptoe or to lift his or her leg while lying prone on the table, face down with legs hanging loosely (Thompson test).
Ultrasound and MRI are useful diagnostic aids.
In mild cases, conservative treatment may suffice. This approach is also preferred in sedentary patients and those who are not fit enough to undergo surgery. It includes immobilizing the affected leg in a plaster cast for about 6 to 8 weeks. The cast is applied, with the foot pointing downwards (this allows for better approximation of the ruptured tendon ends).
Recent research has shown that the patient may recover better and faster if the immobilization period is shortened to about two weeks. Instead of casts, removable boots are available to be used during weight-bearing activities.
Walking boots for Achilles tendon rupture treatment
Light stretching and physiotherapy should be initiated after two weeks. This allows for better tissue repair and improved strength, as well as rapid recovery.
Some surgeons favor early surgical treatment of the ruptured tendon. Although surgery carries its own risks, such as secondary infection, deep vein thrombosis, etc., it is said to decrease the risk of re-rupturing the tendon.
However, many recent studies suggest that both conservative and surgical approaches produce equal results as far as range of motion and re-rupturing of the tendon is concerned.
Surgical treatment options include:
The overlying skin is incised and the ruptured tendon ends are stitched together. The tendon may further be strengthened using another tendon (of a vestigial muscle) or an artificial mesh such as collagen, etc.
The tendon is approached by making several small cuts in the skin, instead of one large incision. It provides a better option for aged, less active or sick patients who may have compromised circulation and healing capacity.
Post-surgically, the foot is immobilized for about two weeks, followed by physiotherapy. Use of orthoses help improve patient comfort during the healing phase.
Orthotics that will help to treat Achilles Tendon Rupture can be found below.