What is it?
The Achilles tendon is a strong band of tissue that connects the calf muscles to the heel. It acts to help the foot rise up on the toes and to push off during walking or running. Achilles tendon ruptures occur when a sudden, forceful movement overstressed the calf muscle. This is commonly seen in sports including football and basketball. Middle aged adults, or weekend warriors, are also prone to this injury.
WHAT ARE SIGNS AND SYMPTOMS OF AN ACHILLES TENDON RUPTURE?
Common symptoms of Achilles tendon ruptures include:
• The feeling of being kicked in the back of the leg
• An audible pop
• Pain with walking
• Difficulty standing on the toes
• Difficulty pushing off on the injured leg
Diagnosis
In the office, a complete history and physical exam is obtained. The Achilles tendon is examined and palpated for a defect or gap. The Thompson test is performed by squeezing the calf and checking for a reflexive ankle motion. Absence of this motion is suggestive of an Achilles tendon rupture. Imaging studies, such as an X-Ray or MRI, is generally not necessary to confirm the diagnosis.
Treatment
Conservative management of Achilles tendon ruptures can be performed in partial tears or in less active, or sedentary, patients. Patients are initially placed in a walking boot with the ankle pointed down for six weeks. Physical therapy begins around 3-4 weeks following the injury. Once the boot is removed, range of motion and gait training is initiated.
Surgical treatment of Achilles tendon ruptures is generally recommended in active individuals who wish to return to their sport or activity. Percutaneous Achilles repair is a minimally invasive technique of repairing the torn tendon through a small incision. This technique provides the principles of a traditional Achilles repair without the need of a large incision. Recent studies have demonstrated this technique as an effective treatment option in the elite athletes in the National Football League (NFL).
RECOVERY
Following surgery, patients are placed in a cast for two weeks and transitioned into a walking boot for the next six weeks. Strengthening of the Achilles tendon begins at three months postoperatively. Jogging is then permitted at 5-6 months post-operatively. Patients can generally return to their sport or activity at 9-12 months.
PERCUTANEOUS ACHILLES REPAIR
The following animation demonstrates a percutaneous repair of the Achilles tendon. A small horizontal incision is made at the level of the Achilles tear. A repair jig is then slid up the tendon, and the sutures are passed through the skin and tendon through the numbered slots. This is then repeated on the other side of the tear. The sutures from each torn end are then pulled out of the incision and tied together, completing the repair.