The Achilles' tendon is located in the leg just behind and above the heel. As the connection between the heel and calf muscle, its function is to allow the bending of the foot downwards. Generally if
there is a tear to the Achilles' tendon it will be known as a rupture. This can be a partial tear or a complete tear, although partial tears are much rarer.
The tendon usually ruptures without any warning. It is most common in men between the ages of 40-50, who play sports intermittently, such as badminton and squash. There was probably some degeneration
in the tendon before the rupture which may or may not have been causing symptoms.
Whereas calf strains and tendonitis may cause tightness or pain in the leg, Achilles tendon ruptures are typically accompanied by a popping sensation and noise at the time of the injury. In fact,
some patients joke that the popping sound was loud enough to make them think they?d been shot. Seeing a board-certified orthopedic surgeon is the best way to determine whether you have suffered an
Achilles tendon tear.
The diagnosis of an Achilles tendon rupture is made entirely on physical examination. Often, there is a substantial defect in the Achilles from 2-5 cm before it inserts into the heel bone. However,
the main test is to determine whether the Achilles has been ruptured is the Thompson test. This essentially involves placing the patient on their stomach and squeezing the calf muscle. If the
Achilles is intact, the foot will rise [plantar flex]. If it is ruptured, the foot will not move and will tend to be in a lower lying position.
Non Surgical Treatment
You may need to wear a plaster cast, brace or boot on your lower leg for six to eight weeks to help the tendon heal. During this time, your doctor will change the cast a number of times to make sure
your tendon heals in the right way. If your tendon is partially ruptured, your doctor will probably advise you to have this treatment instead of surgery. It?s also suitable for people who aren't very
physically active. However, there is a greater risk that your tendon will rupture again, compared with surgery. Your doctor will advise you which treatment is best for you.
In general, for complete tear of the tendon, surgery is recommended. For partial tears, nonsurgical treatment is recommended. However, the selection of treatment depends on the patient, age, level of
activity, and other risk factors. Surgery for Achilles tendon rupture is now routine and well established. Surgery is generally suggested for the young, healthy and active individuals. For athletes,
surgery is often the first choice of treatment. The Achilles tendon can be repaired surgically by either a closed or open technique. With the open technique, an incision is made to allow for better
visualization and approximation of the tendon. With the closed technique, the surgeon makes several small skin incisions through which the tendon is repaired. Irrespective of type of treatment, a
short leg cast (plaster) is applied on the operated ankle after completion of the procedure. The advantages of a surgical approach includes a decreased risk of re-rupture rate (0%-5%) the majority of
individuals can return to their original sporting activities (within a short time), and most regain their strength and endurance. Disadvantages of a surgical approach include hospital admission,
wound complications (for example, skin sloughing, infection, sinus tract formation, sural nerve injury), higher costs, and hospital admission.