About
The Achilles tendon is a band of tissue that runs down the back of the lower leg and connects the calf muscle to the heel bone. Achilles tendon facilitates walking by helping to raise the heel off the ground. An Achilles tendon rupture can be a complete or partial tear that occurs when the tendon is stretched beyond its capacity. Less commonly, chronic illness or medications, may weaken the tendon and contribute to ruptures.
Signs and Symptoms
A person with a ruptured Achilles tendon may experience sudden pain in the back of the ankle or calf. A popping or snapping sensation, swelling on the back of the leg and above the heel, difficulty in tiptoe standing and pain during walking.
Diagnosis
The diagnosis of an Achilles tendon rupture is made by clinical examination. USG or MRI is required to confirm the diagnosis. X-rays may be required to assess Haglund’s bump (bony prominence) or a retrocalcaneal spur that may be associated with insertional tendoachilles tears.
Treatment
Treatment options for an Achilles tendon rupture include surgical and non-surgical approaches. It depends on the chronicity of the tear and the site of the tear.
While mid-substance tears can be managed both surgically and non-surgically, surgery is required in case of insertional tears.
Surgery
Surgery offers important potential benefits. Besides decreasing the likelihood of re-rupturing the Achilles tendon, surgery often increases the patient’s push-off strength and improves muscle function and movement of the ankle.
Mid-substance tears:
Various surgical techniques are available to repair the rupture. In acute tear end to end suturing of the torn end may be sufficient. In chronic and retracted tears often require lengthening or supplementation by other tendons.
Figure- Tear in heal ligament being suture.
Insertional tears:
Requires excision of the bony bump(Haglund’s bump)predisposing to the tear-Calcaneoplasty & repair of the tendon back to the bone using suture anchors.
Figure: Pre-op X-ray showing a retrocalcaneal spur operative image of tear
Calcaneoplasty & TA reattachment
Following surgery, the foot and ankle are initially immobilized in a cast for 6 weeks. Gradually exercises that strengthen the muscles and improve the range of motion of the foot and ankle are started.