Treatment of Achilles tendon ruptures: surgery, rehabilitation

According to statistics, most of the ruptures of the Achilles tendon are recorded among people engaged in active sports. This is a trauma in which the tendon that connects the muscles of the posterior part of the tibia to the calcaneus is broken completely or partially.

With this damage you can feel a click or a crack, after which there is a sharp pain in the shin and back of the ankle. Trauma almost always interferes with normal walking, and many doctors recommend surgery as the most effective method of treating the rupture. Nevertheless, more conservative approaches may also prove to be effective.

Symptoms

Although tendonitis of the Achilles tendon and its subsequent rupture can pass asymptomatically, most people notice one or more signs of damage:

• Pain (often severe and accompanied by swelling in the ankle region);
• Inability to bend the foot in a downward direction or push the patient off the ground while walking;
• Inability to stand on the fingertips on the injured leg;
• Snapping sound or crackling at the time of the tendon rupture.

Even if there is no pain syndrome as such, you need to seek medical advice immediately after you hear a click or a crack in the heel, especially if immediately after this sound you have lost the ability to walk normally.

Causes

Achilles tendon helps to lower the moving part of the foot down, to rise on tiptoe and push off the foot from the ground while walking. It turns out to be somehow involved every time you move your foot.

The rupture usually occurs at a site six centimeters above the joint of the tendon with the calcaneus. This site is especially vulnerable, since blood circulation is difficult here. For the same reason, the tendon very slowly heals after trauma.

Known are very common examples of ruptures of the Achilles tendon caused by a sharp increase in the load:

• Increasing the intensity of sports, especially if they include jumping;
• falling from height;
• Hit the foot in the hole.

Risk factors

Some circumstances increase the risk of rupture of the Achilles tendon:

• Age. Most often, trauma of this type is observed in patients from thirty to forty years.
• Floor. According to statistics, there are five men with a rupture of a tendon per woman patient.
• Doing sports. Most often, the damage is caused by physical activity, including running, jumping and alternating sudden movements and stops. Examples are football, basketball, tennis.
• Injection of steroids. Doctors sometimes prescribe injections of steroids into the ankle joint to reduce the pain syndrome and relieve the inflammatory process. However, these substances can weaken nearby tendons and eventually lead to ruptures.
• Reception of some antibiotics. Fluoroquinolones, such as "ciprofloxacin" or "levofloxacin", increase the trauma of everyday activities.

Before a visit to a doctor

Given that the rupture (as well as simple inflammation) of the Achilles tendon can lead to an inability to walk normally, you should immediately seek medical help. Perhaps you will have to visit a doctor specializing in sports medicine or orthopedic surgery.

In order to make the consultation as effective as possible, write down the following information on paper immediately before taking it:

• A detailed description of the symptomatology and the preceding case, which caused trauma;
• Information about past health problems;
• List of all medicines and food additives taken;
• Questions that you would like to ask the doctor.

What will the doctor say?

The specialist will most likely ask you the following questions:

• How did the tendon damage occur?
• Did you hear (or, perhaps, did not hear, but felt) a click or crack when getting injured?
• Can you stand on your fingertips on a damaged leg?

Diagnostics

At the initial medical examination the doctor will examine the shin for sensitivity and swelling. In many cases, a specialist can manually feel the discrepancy in the tendon, if it has completely ruptured.

Perhaps the doctor will ask you to stand on a chair on your knees or lie on your stomach on the table for examination so that your feet hang from the edge of the table. With this method of diagnosis, the doctor compresses the calf muscle of the patient to check the reflex: the stop should automatically bend. If it remains immobile, most likely, there was inflammation of the Achilles tendon. It was this that ultimately led to trauma.

If there was a question about the degree of damage (that is, if the tendon has completely ruptured or only partially), the doctor will prescribe an ultrasound or magnetic resonance imaging. Thanks to these painless procedures, you can take detailed pictures of any tissues and organs in the body.

Treatment

Many people to some extent damage the Achilles tendon. Treatment often depends on the age, level of physical activity and the severity of the injury. In general, young patients and physically active people usually choose surgical intervention, this is the most effective method. Patients of older age groups tend to tend to conservative treatment. According to recent studies, correctly prescribed conservative therapy can be no less effective than the operation.

Treatment without surgery

With this approach, patients usually wear special orthopedic shoes with a platform under the heel - it allows the severed tendon to heal independently. This method eliminates many operational risks, such as infection. However, recovery with orthopedic footwear takes much longer than trauma treatment through surgery, and there is a high risk of re-rupture. In the latter case, still have to resort to surgery, but there is a high probability that the surgeon will now be much more difficult to fix the rupture of the Achilles tendon.

Operation

Usually, surgical intervention is as follows. The doctor makes a cut at the back of the lower leg and stitches the torn parts of the tendon. Depending on the condition of the damaged tissue, it may be necessary to strengthen the joints with other tendons. Among possible complications after surgery are infections and nerve damage. The risk of infection is significantly reduced if during the operation the surgeon produces small incisions.

Contraindications

Treatment of the Achilles tendon ruptures by the operative method is contraindicated for those diagnosed with an active infection or a skin disease in the area of trauma. Conservative therapy is also prescribed for patients with a general unsatisfactory state of health, diabetes, a predilection for smoking. Contraindications are also such circumstances as a sedentary lifestyle, the use of steroids and the inability to follow the surgical instructions of the surgeon. Any questions about your health should be discussed with your doctor in advance.

Rehabilitation

To finally heal the rupture of the Achilles tendon (after surgery or conservative therapy - it does not matter), you will be assigned a rehabilitation program that includes physical exercises for training the muscles of the legs and Achilles tendon. Most patients return to their usual lifestyle four to six months after the end of therapy or surgery.

Exercises

After conservative treatment, rehabilitation exercises can begin right after the disappearance of the pain syndrome, after surgical intervention - as soon as the surgical wound heals. Physical activity is the key to complete recovery after injury (especially if this trauma is a rupture of the Achilles tendon). Rehabilitation begins with a massage and increases the overall mobility of the ankle - the feeling of stiffness should disappear. After two weeks of gentle therapy, active exercises are prescribed, and the best results can be achieved by shining a much-needed physical load from 12 to 16 weeks. The load begins with the stretch, then goes to the power exercises, including flexing and straightening the knee.

If the pain syndrome has passed completely, you can connect to training more sports-oriented load. It is advisable for athletes to go for jogging and to make more jumps. Recurrent tendonitis of the Achilles tendon and subsequent re-rupture will become much less likely if the patient carefully adheres to the prescribed rehabilitative measures.