Anatomy/Symptoms
The Achilles tendon is the strongest and thickest tendon in the body. It is the tendinous extension between the calf muscle (gastrocnemius and soleus muscles) and the heel bone. When the calf muscles contract and pull the Achilles tendon, the heel rises and the foot points downward. This allows actions such as jumping, running, walking and standing on your toes.
Achilles tendon rupture often occurs spontaneously in healthy, active people as a result of overstretching during sporting activities, or as a result of a direct trauma to the tendon. Risk factors for rupture include: previous Achilles injury; changes in training or activity levels and age.
Symptoms of an Achilles rupture include: a loud ‘pop’ at rupture; pain as if having been hit on the back of the leg; swelling; and an inability to walk properly. There may be a visible or palpable gap in the tendon where it has ruptured.
Non-operative treatment
Non-operative treatment is usually only indicated in elderly, inactive patients, or in those patients whose co-existing medical conditions present significant surgical risks. Without surgery, full strength of the tendon and muscle does not return.
To alleviate the symptoms of a ruptured Achilles, analgesics and anti-inflammatories may be prescribed. A special walking boot may be applied to immobilize the tendon and calf muscle, yet allow some degree of mobilization until surgery is performed.
Opeative Treatment - Percuutaneous Repair of Ruptured Achilles Tendon
A percutaneous repair usually requires three small incisions over the Achilles tendon. A strong suture is woven through the tendon and used to reattach the two ends of the tendon. A fiberglass cast or a plaster backslab will be applied to the leg post-operatively to maintain it in a position that best enables the tendon to heal, ie. the foot is angled 90 degrees to the leg.
Post-Opeative Treatment
Your leg will remain in the removable splint (Donjoy walkabout boot) for 6 weeks - you will need crutches during this time to assist with non-weightbearing mobilization.
From 6-12 weeks, you can start weight-bearing mobilization and reduce the use of your crutches as able. Continue to wear the boot as instructed by Dr Mansfield.
From 3-6 months post surgery, you should be able to walk in regular shoes with a heel raise insert of 1 - 2 cm. Bike riding and swimming can also commence at this stage.
Return to full activity is usually expected at around 6 months.
Possible risks of this surgery include: