ACHILLES TENDON RUPTURE

The Achilles tendon is the tendon that connects your calf muscles to your heel. You use it for jumping and standing on tiptoe. You can rupture or tear it either partially or completely when jumping, by forcefully bending the foot toward the shin, or by receiving a direct blow. Men aged 40 to 50 years who are occasional athletes are the most common victims, but it can occur at any age. History and a physical examination will usually identify the injury. Sometimes it is treated with casting, but it usually requires surgery for repair. Recovery is slow and may take up to 6 months, but is usually complete.

Living With Your Diagnosis

The most common symptom of an Achilles tendon tear is stabbing pain at the lower calf at the time of injury. Frequently, you will not be able to walk without pain, especially when you try to push off of the toe. Swelling is seen at the site of injury. The calf muscles may appear bunched up. You may be unable to stand on tiptoe on the injured foot.

Treatment

The most common treatment for a complete Achilles tear is surgery. After surgery, the foot is immobilized with a cast that keeps the toe pointed down somewhat. This is changed in about 3 weeks to a smaller cast that holds the foot at more of a 90-degree angle. This is removed in about 4 more weeks, and any wires put in to hold the tendon together until healed are taken out at that time. Your doctor will probably advise a heel lift or high-heeled shoe for another couple of months after that. If it is possible to get the ends of the tendon back together without surgery, your doctor may recommend casting for 10 to 12 weeks, with cast changes at 6 weeks and around 8 to 9 weeks. You will be placed in a heel lift for around 3 months after removal of the last cast. In any case, with exercise and physical therapy, most individuals will have a full recovery.

The DOs

You should take pain medicines as prescribed. You should protect your cast because it is crucial to protect the tendon until it has a chance to heal, and that will take time. After the cast removal, you should follow instructions for physical therapy and exercise to recover muscle strength and range of motion at the ankle. Proper conditioning is important to prevent reinjury of the tendon. If you have a partial tear of the tendon, it is essential to follow your rehabilitation prescription to the letter. There is a significant risk of complete rupture if the tendon is stressed too much before it can heal.

The DON'Ts

You should avoid cortisone or steroid injections around the Achilles tendon because the injections are a significant risk factor for Achilles tendon rupture. If you have a rupture, you should not remove or damage your cast. If you tear the repair loose, you start over again in your course of treatment, and this will significantly prolong your time to complete healing. You should not do anything that will cause excessive force on the tendon until healing is complete because of the risk of reinjury. For this reason, you should follow your physical therapy instructions to the letter until released to full activity.

When to Call Your Doctor

You should call your doctor if you damage your cast. If you have had an injury repaired, you should call your doctor if you experience a reinjury. You should also call if you have increasing symptoms of pain in the calf or are unable to rise onto tiptoe or walk. These may be signs of reinjury, as may increased swelling at the site of injury.

For More Information
Description of the injury and surgery
http://www.medmedia.com/05/243.htm"

The Thompson test or "squeeze" test for complete rupture of the Achilles tendon. With an intact or partially torn tendon, squeezing the calf muscles produces passive plantar flexion of the ankle. With loss of continuity of the Achilles tendon, this maneuver fails to produce ankle motion. (From Burke JH, Boyd RJ, McCade CJ: Trauma management–early management of visceral, nervous system, and musculoskeletal injuries, ed 1, St Louis, 1988, Mosby. Used by permission.)

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