Overview
A total rupture of the achilles tendon is a complete tear of the tendon and typically affects men over the age of 40 involved in recreational sport. A complete rupture of the achilles tendon is not always recognized at the time of injury, however it is very important it is treated properly as soon as possible to increase the chances of a good recovery.
Causes
The causes of an Achilles tendon rupture are very similar to Achilles tendinitis. Causes include. Running uphill. Running on a hard surface. Quickly changing speeds from walking to running. Playing sports that cause you to quickly start and stop.
Symptoms
Patients present with acute posterior ankle/heel pain and may give a history of felt like someone kicked me from behind. Patients may report a direct injury, or report the pain started with jumping or landing on a dorsiflexed foot. It is important to elicit in the history any recent steroid or flouroqunolone usage including local steroid injections, and also any history of endocrine disorders or systemic inflammatory conditions.
Diagnosis
The diagnosis of an Achilles tendon rupture is made entirely on physical examination. Often, there is a substantial defect in the Achilles from 2-5 cm before it inserts into the heel bone. However, the main test is to determine whether the Achilles has been ruptured is the Thompson test. This essentially involves placing the patient on their stomach and squeezing the calf muscle. If the Achilles is intact, the foot will rise [plantar flex]. If it is ruptured, the foot will not move and will tend to be in a lower lying position.
Non Surgical Treatment
Achilles tendon ruptures can be treated non-operatively or operatively. Both of these treatment approaches have advantages and disadvantages. In general, younger patients with no medical problems may tend to do better with operative treatment, whereas patients with significant medical problems or older age may be best served with non-operative treatment. However, the decision of how the Achilles tendon rupture is treated should be based on each individual patient after the advantages and disadvantages of both treatment options are reviewed. It is important to realize that while Achilles tendon ruptures can be treated either non-operatively or operatively, they must be treated. A neglected Achilles tendon rupture (i.e. one where the tendon ends are not kept opposed) will lead to marked problems of the leg in walking, which may eventually lead to other limb and joint problems. Furthermore, late reconstruction of non-treated Achilles tendon rupture is significantly more complex than timely treatment.
Surgical Treatment
There are two types of surgery to repair a ruptured Achilles tendon. In open surgery, the surgeon makes a single large incision in the back of the leg. In percutaneous surgery, the surgeon makes several small incisions rather than one large incision. In both types of surgery, the surgeon sews the tendon back together through the incision(s). Surgery may be delayed for about a week after the rupture, to let the swelling go down.
A total rupture of the achilles tendon is a complete tear of the tendon and typically affects men over the age of 40 involved in recreational sport. A complete rupture of the achilles tendon is not always recognized at the time of injury, however it is very important it is treated properly as soon as possible to increase the chances of a good recovery.
Causes
The causes of an Achilles tendon rupture are very similar to Achilles tendinitis. Causes include. Running uphill. Running on a hard surface. Quickly changing speeds from walking to running. Playing sports that cause you to quickly start and stop.
Symptoms
Patients present with acute posterior ankle/heel pain and may give a history of felt like someone kicked me from behind. Patients may report a direct injury, or report the pain started with jumping or landing on a dorsiflexed foot. It is important to elicit in the history any recent steroid or flouroqunolone usage including local steroid injections, and also any history of endocrine disorders or systemic inflammatory conditions.
Diagnosis
The diagnosis of an Achilles tendon rupture is made entirely on physical examination. Often, there is a substantial defect in the Achilles from 2-5 cm before it inserts into the heel bone. However, the main test is to determine whether the Achilles has been ruptured is the Thompson test. This essentially involves placing the patient on their stomach and squeezing the calf muscle. If the Achilles is intact, the foot will rise [plantar flex]. If it is ruptured, the foot will not move and will tend to be in a lower lying position.
Non Surgical Treatment
Achilles tendon ruptures can be treated non-operatively or operatively. Both of these treatment approaches have advantages and disadvantages. In general, younger patients with no medical problems may tend to do better with operative treatment, whereas patients with significant medical problems or older age may be best served with non-operative treatment. However, the decision of how the Achilles tendon rupture is treated should be based on each individual patient after the advantages and disadvantages of both treatment options are reviewed. It is important to realize that while Achilles tendon ruptures can be treated either non-operatively or operatively, they must be treated. A neglected Achilles tendon rupture (i.e. one where the tendon ends are not kept opposed) will lead to marked problems of the leg in walking, which may eventually lead to other limb and joint problems. Furthermore, late reconstruction of non-treated Achilles tendon rupture is significantly more complex than timely treatment.
Surgical Treatment
There are two types of surgery to repair a ruptured Achilles tendon. In open surgery, the surgeon makes a single large incision in the back of the leg. In percutaneous surgery, the surgeon makes several small incisions rather than one large incision. In both types of surgery, the surgeon sews the tendon back together through the incision(s). Surgery may be delayed for about a week after the rupture, to let the swelling go down.