achilles tendon rupture - orthoam.com.au · achilles tendon rupture acute rupture: a common...

AchillestendonruptureAcuteRupture:AcommonscenarioforAchillesruptureoccursinthemiddleagemalewhoundertakesexplosiveactivitysuchasagameofsquash.Bythisagethetendonoftenhasundergonesomedegenerativechangeandmayfailtosustainasuddenstrongresistedmusclecontraction.Thisinjuryhowever,canoccurinanyone.Thefeelingisofbeinghitinthebackofthecalfbyacricketbat.

WhendiagnosedearlyamidsubstanceAchillesrupturecanbetreatedwithoutanoperation.Ideally,ifthetwoendsoftherupturedtendon

canbebroughtintocontactbyplacingtheankleinplantarflexion(pointingthetoe)thenitshouldheal.Theinjurycanalsooccurlowerdownattheinsertionintothecalcaneus(heelbone)orhigheratthemusculotendinousjunctioninwhichcasetheimplicationsmightbedifferentandwillbediscussedatyourconsult.ThesurgicaloptionistohaveanAchillesrepair.Itreducesslightlytheriskofre-ruptureinthefutureandgivesaslightedgeinmaximumsportsperformance.Thisoptioninvolvestheriskofsurgerysuchasinfection,woundbreakdownandnerveinjury.Thesurgerytakesapproximately30minutesandcanbedonethroughanapproximately5cmincision,sometimessmaller.Anacceleratedrehabilitationprogramisusuallyrecommendedregardlessofthechoicebetweensurgeryvsnosurgeryandmustbecloselyadheredtoandbesupervisedbyaphysiotherapist.Aplantarflexioncast(withthetoepointed)isusedinitiallybeforea2weekwoundassessmentandtransitioningtoabootwithaheelraise.ThePhysiotherapistcanthensuperviseyourrehabandyoucanexpecttostartsportspecifictrainingat3monthsbutitisgenerallyrecommendedtotake12monthsofffromseriousrunningandexplosive“pushoff”typesports.ChronicAchillestendonrupture.TherearesituationswhereanAchillesrupturemaynotbediagnosedandtreatedinthefirstfewweeks.Atthisstagethegapbetweentheendsofthetendoncannotbeclosedwithasimplerepair.Thismayinvolveareconstructiveprocedurewhereextralengthtobridgethegapisgainedfromfurtherupthecalf.ThisinvolvesalargerincisionandbecomesasimilarscenariotothatseeninNonInsertionaltendinopathywhichisexplainedearlierinthisinformationsheet.