What are the symptoms of an Achilles tendon rupture?
An Achilles tendon rupture is a traumatic injury that causes sudden pain behind the ankle. Patients may hear a 'pop' or a 'snap,' and will almost always say they feel as though they have been kicked in the heel (even though no one has kicked them). Patients have difficulty pointing their toes downward, and may have swelling and bruising around the tendon.
Which patients sustain Achilles tendon ruptures?
Achilles tendon ruptures are most commonly seen in men who are around the age of 30-40 years old. About 15-20% of patients have symptoms of Achilles tendonitis prior to sustaining an Achilles tendon rupture, but the vast majority of patients have no history of prior Achilles tendon problems. Over 75% of Achilles tendon ruptures are associated with playing ball sports (commonly basketball or tennis).
Other risk factors that are associated with Achilles tendon rupture include:
- Cortisone injections into the tendon
- Gout
- Fluoroquinolone antibiotic use
What is the treatment for Achilles tendon rupture?
Achilles tendon rupture is most often treated surgically to reattach the tendon to its normal position.
Nonoperative management can be undertaken, generally people who live sedentary lifestyles or who may have problems with wound healing. Nonsurgical treatment of an Achilles tendon rupture is accomplished by casting the Achilles tendon for several months. In these patients, the number of reruptures is higher compared to those patients who have surgical repair. In patients who have surgery for an Achilles tendon rupture, less than 3% experience a rerupture of the tendon.
How is surgery done for treatment of an Achilles tendon rupture?
The surgery to treat an Achilles tendon rupture involves an incision along the back of the ankle. Usually the incision is made just to the side of midline so shoes will not rub on the site of the scar. The torn ends of the Achilles tendon are identified and strong sutures are placed in both ends of the tendon. These strong sutures are then tied together to repair the tendon.
What are the complications of Achilles tendon repair?
The most common and worrisome complications following an Achilles tendon repair are problems with wound healing. The skin over the Achilles tendon sometimes does not heal well. Therefore, careful wound management is of utmost important following surgical repair of an Achilles tendon rupture. Other potential problems include infection, ankle stiffness, and rerupture of the tendon.
What is the rehab following Achilles tendon repair?
Rehabilitation following Achilles tendon repair is a controversial topic. Traditionally, patients were casted after surgery for a period of 4 to 8 weeks and after that time, patients were allowed to gently move the ankle.
More recently, studies have shown that patients do well and heal faster with more rapid mobilization. If a solid repair is attainable, patients may not be casted at all, and allowed to begin motion immediately after surgery. These patients will use a removable boot when walking for several weeks.
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