Achilles tendon rupture

Autor: RAFAŁ CZEPUŁKOWSKI
Consultation SZYMON RUBCZAK
Date added 04.12.2024
Date of last revision 04.12.2024

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The Achilles tendon is a large set of fibers at the back of the ankle joint, the popular ankle, which connects the gastrocnemius muscle to the heel. It is responsible for the up and down movement of the foot, toe climbing and, most importantly, for efficient walking. Its rupture is a serious injury, and downplaying ailments in this area can have unpleasant consequences.

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Rupture of the Achilles tendon can be total or partial. Most often it occurs as a result of overstretching of the tendon with simultaneous tension of the gastrocnemius muscle. Characteristically, there is a cracking sensation described by patients as a blow to the calf or a smack of the whip. The middle section of the Achilles tendon is most often exposed to rupture.

What should I do if I suspect an Achilles tendon injury?

  • do not put weight on the injured leg
  • rest and limit the amount of movement
  • cool down the joint where the Achilles is ruptured
  • apply compression (elastic) bandages
  • contact your doctor

Chronic pathologies - causes of Achilles injury

Rupture can also occur, and quite often, as a result of chronic pathologies. Inflammatory changes that weaken the tendon lead to the formation of micro-injuries. They are common in runners and, if left untreated, can severely damage the fibers of the Achilles tendon. Disturbing signals are: pain, crackling (friction) during movement, warming up, widening of the outline of the tendon. If they occur, it is recommended to consult an orthopedist, perform an ultrasound examination, limit exercise and implement treatment (rehabilitation, biological treatment).

Injuries to the Achilles tendon also occur in people who have not had similar symptoms before: athletes, active people. In such cases, tendon rupture occurs as a result of biomechanics disorders and too much training load. Preparation is also sometimes incorrect - lack of warm-up, dehydration, exertion during a systemic infection. People most at risk of Achilles tendon rupture are those who participate in sports that involve frequent jumping, changes in direction of movement and sudden acceleration (handball, tennis, squash, badminton, basketball, volleyball).

Rupture of the Achilles tendon - symptoms:

  • damage to the Achilles tendon,
  • severe pain radiating to the heel,
  • bruising on the heel,
  • swelling,
  • inability to walk on the injured leg,
  • difficulty in bending the toes downward,
  • a characteristic sound when the tendon breaks.

Untreated pain can lead to rupture of the tendon, and untreated rupture can lead to impaired function of the ankle joint and limping on the affected limb. If you have pain in this area do not underestimate it, contact an orthopedist!

Rupture of the Achilles tendon - diagnosis

Of greatest importance is the history, clinical (medical) examination and additional tests, such as ultrasound of the Achilles tendon or MRI. Most often, the injury is accompanied by pain in the area of the tendon, there is hematoma and swelling of the calf area, restriction of dorsiflexion movement of the foot, inability to climb on the toes. The doctor, performing the examination, checks for continuity of the tendon and whether it carries the load (Thompson test).

Ultrasound of the Achilles tendon confirms the damage, allows to determine at what height the rupture occurred and how far apart the ends of the tendon are (the so-called retraction). This is important for the selection of a possible surgical technique to restore continuity.

Total and partial rupture of the Achilles tendon - treatment methods

After the main examination and additional tests, the doctor can determine whether the tendon is ruptured completely or partially. We can treat some partial damage conservatively by immobilizing the limb (orthopedic shoe, cast) and using biological treatment - cell-rich plasma or other growth factors. In the case of complete damage, we can opt for surgical or conservative treatment. Conservative treatment is mostly used for people with contraindications to surgery. Such a choice involves long-term (about 10 weeks) immobilization of the ankle joint. The second option is surgical treatment.

Achilles tendon surgery - Achilles suture

Completely ruptured Achilles tendon. Suturing of the tendon, can be carried out by the "open" method or percutaneously. The preferred method is the mini-invasive percutaneous Achilles suture. The procedure involves approximating the stumps of the tendon with a special suture carried out through small incisions in the skin. This method allows the soft tissues to heal faster after the procedure and shortens the recovery time. Rehabilitation after Achilles tendon rupture is also implemented much faster. In more complicated cases, such as at the level of the tendon's attachment to the heel bone, treatment is carried out using the open method.

In advanced damage, e.g. on the basis of tendinopathy, or in the case of stagnant, contracted damage with shortening of the tendon and muscle, we propose treatment involving tendon reconstruction using tendons of the sciatic and knee muscles (the patient's own tendons often used in anterior cruciate ligament reconstructions). In this method, both percutaneous and "open" treatment is possible. This is an innovative method that allows people who have often been denied surgical treatment due to being too late from rupture to recover. It is also a method used successfully in recurrent injuries.

At Rehasport, we perform Achilles tendon suturing in a safe and professional manner, taking care of our patients' comfort and well-being at every stage of the procedure. With us you will take care of your health and quickly return to physical activity.

Rehabilitation after Achilles tendon rupture

After Achilles tendon surgery, the ankle joint is immobilized in a position of plantar flexion (to eliminate tension on the repaired tendon). Orthopedic shoes or a synthetic cast are used for this. During the first weeks, the patient moves around with the assistance of elbow crutches. After two weeks, during a follow-up visit, the doctor removes the sutures and rehabilitation of the Achilles tendon begins. The standard immobilization period lasts about six weeks, with the angle of immobilization of the foot in the orthosis changing over time.

Rehabilitation in the first period is aimed at healing post-operative wounds (reducing the formation of adhesions), then the range of motion in the ankle joint is gradually restored. The next stage is to rebuild the strength of the triceps calf muscle, followed by deep sensory training. At each stage, rehabilitation after Achilles tendon rupture also involves shaping appropriate movement patterns and training neuromuscular control and proprioception.

It takes 4-8 months to return to full function after a complete Achilles tendon rupture, depending on the treatment used and the intensity of rehabilitation. At each stage, treatment is monitored, with factor therapy applied if necessary. Each time treatment should be completed with a biomechanical evaluation, the correct results of which are a prerequisite for a safe return to sports activities.

Related articles:

Learn about other possible foot and ankle injuries.

Bibliography:

Autor
RAFAŁ CZEPUŁKOWSKI
RAFAŁ CZEPUŁKOWSKI

Specjalista do spraw content marketingu, dziennikarz sportowy i medyczny. Redaktor naczelny magazynu „Poradnik Zdrowie i Sport”, członek Dziennikarskiego Klubu Promocji Zdrowia, współtwórca wielu artykułów medycznych z zakresu ortopedii i urazowości w sporcie.

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Konsultacja merytoryczna
SZYMON RUBCZAK
SZYMON RUBCZAK

Lekarz w klinice Rehasport, specjalista Ortopedii i Traumatologii Narządu Ruchu, zajmujący się leczeniem urazów kończyny dolnej, a także ortopedią dziecięcą i leczeniem deformacji kręgosłupa. Swoje szczególne zainteresowania skierował na leczenie artroskopowe oraz medycynę sportową.

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