Achilles Tendon Tears

Ruptures may be acute or chronic. An acute rupture is a rupture that is diagnosed and treated soon after the injury. A chronic rupture is defined as a rupture with a delay in diagnosis or treatment for more than six weeks. The management of chronic ruptures is technically more demanding than the repair of an acute rupture.

High energy sports are the cause of ruptures in middle aged men, who may occasionally participate in sports. Specifically sudden forced flexion of the foot, direct trauma and long-standing degeneration of the tendon are the causes. Sports associated with a rupture include diving, tennis, baseball, cycling, running, volleyball, gymnastics, and track.

In older adults the cause is mostly associated with low-energy injuries including spontaneous rupture of a degenerated Achilles tendon. The tear may be partial or complete.

Risk factors include:

• poor conditioning before exercise
• extended use of steroids
• doing too much/ pushing too hard
• use of certain antibiotics
• diabetes
• thyroid disorders
• family history

Acute ruptures cause sudden and severe pain in the back of your leg, just above the heel. You might hear a pop or snap when the injury occurs. You may feel as though you were kicked in the back of the calf. Other symptoms include swelling, difficulty walking, the inability to stand on the toes, or push off on the injured leg.

Your Center for Orthopedic Specialist clinician will ask how you injured your leg and your symptoms. They will review your medical history and evaluate your risk factors. Then they will perform a physical exam and perform specific tests to assess the tendon.  They will feel for the tendon gap and signs of bruising around the ankle. Your clinician will order x-rays and possibly an MRI or ultrasound. From this evidence, they will form an opinion about your condition and recommend treatments appropriate to your condition.

Conservative, nonsurgical management with rest, elevation, pain control and functional bracing followed by early functional rehabilitation may be appropriate. It is often recommended for patients with significant medical conditions who are sedentary. However, nonsurgical treatment has a re-rupture rate of 40%, compared with only 0.5% after surgery.

Surgical options are designed to reconnect the ends of the torn tendon. There are two options:

• Open surgery involves an incision in the back of the leg. Damaged tissues are removed, and the torn ends of the tendon are sutured together, and may require reattaching the tendon to the heel bone.
• Percutaneous surgery is minimally invasive surgery using several small cuts and small tools to repair the tendon. Repair will involve removal of the damaged tissues and suturing together the torn ends of the tendon and may require reattaching the tendon to the heel bone.
• If the damage is extensive, a tendon transfer may be needed. The tendon used is the one that flexes the big toe. In surgery this tendon is repositioned to anchor it to the heel bone.
• To assist with healing, your surgeon may use a tendon patch made of collagen that dissolves as the tissue heals. Postoperative injections of platelet rich plasma are used to augment repair to stimulate healing.

Studies report good functional results and patient satisfaction with both operative and nonoperative options. However, surgery is often preferred for active patients who desire to return to play because surgical repair or reconstruction offers a faster return to work and reduces the risk of re-injury or re-rupture.

Regardless of the choice of treatment, rehabilitation is critical to regaining maximum ankle function. Aggressive early rehabilitation is advocated for acute tears to allow for early return the activities of daily life.