Most Achilles tendon rupture occurs in middle-aged athletes. Patients often compare it to being kicked in the back of the heel, or feeling a pop as it ruptures.
How does the Achilles rupture?
As we age the blood supply to the Achilles tendon is reduced, leading to weakening of the tendon. A sudden pain in the heel or calf is often felt as the tendon completely ruptures.
Partial and micro tears are also common in the Achilles tendon. Patients usually report a more gradual pain or ache in the heel particularly with running activity.
Investigations
A complete Achilles rupture is usually clinically obvious however an ultrasound or MRI may be requested by your surgeon. These scans can help in the decision making process of whether your rupture will benefit from surgery.
Most cases of partial / micro rupture or tendonitis (inflammation of the tendon) are best imaged with a MRI scan.
Treatment
Both surgical repair of your tendon or non-surgical treatment (early functional rehabilitation) can lead to an excellent clinical result. The type of treatment depends on your tear type, age, activity and sporting level, initial treatment and your own preference. Your surgeon will discuss the pros and cons with you. Surgery is associated with a lower rate of re-rupture and in athletes, better power. However the risk of wound complications and infection is also higher with surgical treatment.
Partial / micro tears and tendonitis are best treated with rest, activity modification and a physiotherapy program. Surgery is reserved for cases that do not respond to this initial treatment.
Surgery
An incision is made over the Achilles tendon and the ends are sutured together. This can be done through a standard incision or if your tear is suitable, a mini incision. You will be placed in plaster after surgery and go home on the same day.
After your surgery
A single dose of antibiotics will be given before surgery
You can leave the hospital when fully awake or stay overnight if you prefer
You will be in plaster for the first 2 weeks, then a moon boot with a heel raise until 8 weeks post surgery. A structured Physiotherapy program will commence from week 2
Your surgeon will discuss the best methods of blood clot prevention for you
You will be seen in clinic 2 weeks post surgery for suture removal
Risks of Achilles tendon repair surgery
Infection / wound breakdown
Re rupture
Blood clots
Ongoing pain / stiffness
Damage to nerves/ blood vessels
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