Acute Achilles Tendon Rupture
Rupture, or tearing, of the Achilles tendon is a common condition. This typically occurs in the unconditioned individual who sustains the rupture while playing sports, or perhaps, from tripping. There is a vigorous contraction of the muscle and the tendon tears. The patient will often describe the sensation that someone or something has hit the back of the calf muscle. Pain is suddenly present, and although it is possible to walk, it is usually painful. More importantly however, the leg is weak. This is particularly noticeable when trying to push off while walking, and there is not sufficient strength to do so.
Non surgical care
While it is possible to treat this ruptured tendon without surgery, this is not ideal since the maximum strength of the muscle and tendon rarely returns. The reason for this is that the ends of the tendon are ruptured in a very irregular manner, almost like the ends of a paint brush. As soon as the tendon ruptures, the calf muscle (gastrocnemius muscle) continues to pull on the tendon, and the end of the ruptured tendon pulls back into the leg, which we call retraction. Once the tendon retracts, it is never possible to get sufficient strength back without surgery, because the muscle no longer functions at the correct biomechanical length, and is now stretched out.
If for one reason or another your doctor does not recommend surgery, it is essential to obtain special tests to check that the ends of the tendon are lying next to each other so that healing can occur. The best test to do this is called an ultrasound, and not an MRI.
There are patients for whom surgery cannot be performed, in particular, due to existing medical conditions which may add to potential for complications following surgery. For these patients, we use a specially designed boot which positions the foot correctly, and takes the pressure and tension off the muscle and tendon. Most importantly however, a cast is never used because it causes permanent shrinkage (atrophy) of the calf muscle. We use a special boot, which permits pressure on the foot with walking, and a hinge is incorporated into the boot to permit movement of the ankle. We have demonstrated in many studies of rupture of the Achilles tendon, that this movement of the foot in the boot while walking is ideal for tendon healing.
Surgical treatment of Achilles tendon rupture
Surgical correction of the ruptured tendon is almost always necessary. This is performed in order to regain the maximum strength of the Achilles, as well as the normal pushing off strength of the foot. The strength of the muscle depends on the correct tension between the muscle and the tendon. The only way that the correct tension on the tendon can set is by accurately repairing the tendon ends. When the tendon ruptures, the ends of the tendon separate and multiple little strands of the tendon are present like pieces of spaghetti. The foot and ankle surgeon is able to repair the ruptured ends of the tendon using a strong, non-absorbable suture material. Sometimes reinforcement of this repair is necessary utilizing the patient's own tendon graft or a biologic substitute.
