The Achilles tendon is the largest tendon in the body, which allows us to push off with forces up to 10 times our body weight.
An Achilles tendon tear, or rupture, usually is a complete gap in the tendon 4-5 cm above the heel bone. The actual mechanism is commonly a rapid loading of an already-tensed tendon, e.g. lunging forward from a standing start.
Commonly it feels like being struck in the back of the ankle, followed by some pain. There often is no pain in this area before the actual tear. After the tear, symptoms range from pain and bruising to weakness in pushing off on the foot.
The Diagnosis is usually on clinical examination, with a gap being able to be felt in the tendon, a lax foot position and a calf squeeze test producing no ankle movement.
Both non-surgical and surgical treatments have been studied with appropriate reasons for choosing either management. The tendon can heal with conservative functional bracing, with good outcomes and similar repeat rupture rates to surgical treatment. It is recommended for patients with low functional demand, or medical issues such as Diabetes or vascular disease.
Surgical repair restores the appropriate length of the tendon and is associated with better strength, and return to sport and higher level activity, with a low repeat rupture rate. It has a faster return to work and normal activities. Surgery has small risks of wound breakdown and infection and deep vein thrombosis.
Conservative therapy utilises a Functional bracing program. Weight bearing is allowed in a Vacoped boot , which can be fitted at MOG. This protects the tendon healing by keeping the foot in a downward (plantar flexed) position.
This is gradually restored to a neutral position over 8 weeks before commencing a rehabilitation program, coming out of the boot around 3 months.
Surgical treatment involves a 2 cm incision and a minimally invasive technique to realign the tendon and repair it with a series of strong sutures. Post operatively weight bearing is allowed in a Vacoped boot. After 2 weeks of elevation a functional rehabilation program is commenced, coming out of the boot 8 weeks following surgery. A calf strengthening program is then commenced.