Achilles Tendon Rupture

A complete tear of Achilles tendon tends to occur in middle aged patients. Partial rupture occur in trained athletes and involve the lateral aspect of the tendon. Acute Achilles tendon tear commonly result from acute eccentric overload on the dorsiflexed ankle that has chronic tendinosis. Patients should be questioned about previous steroid injections and fluoroquinolones (possible link with tendon weakening).

Causes Achilles Tendon Rupture:

Injuries to Achilles tendon result from repeated stress on the tendon, which may be caused by:
  • Overuse
  • Running on hills and hard surfaces
  • Poor stretching habits
  • Tight calf muscles
  • Weak calf muscles
  • Worn-out or ill-fitting shoes
  • Flatfeet
Rupture most commonly occurs in the middle-aged male athlete. As one age, the Achilles tendon weakens and become thin, making it more susceptible to injury.

Symptoms Of  Ruptured Achilles Tendon
  • A sudden sharp pain as if someone has whacked you in the back of the leg with something.
  • This will often be accompanied by a load snap or bang noise.
  • You will be unable to walk properly and unable to stand on tip toe.
  • There may be a gap felt in the tendon.
  • There will be a lot of swelling.
  • A positive result for Thompson Test.
Diagnosis Of Achilles Tendon Rupture:

Thompson Test:
The patient is placed prone, with both feet extended off the end of the table. Both calf muscles are squeezed by the examiner alternately and compared. If the tendon is intact, the foot will plantar flex when the calf is squeezed. If the tendon is ruptured, normal plantar flexion will not occur (positive test sign).

Partial ruptures are also difficult to accurately diagnose, and MRI and Ultrasound should be used to confirm the diagnosis.

     Treatment For Achilles Tendon Rupture

There are two methods of treatment;
  1. Nonoperative Treatment of Acute Achilles tendon tear
  2. Operative Treatment of Acute Achilles tendon tear
The speed at which a patient can progress with the rehabilitation will vary and should at all times be done under the supervision of a qualified professional.

Non-operative Treatment of Achilles tendon Rupture:

Immediately following injury:
  • Rest
  • Ice
  • Compression
  • Elevation
Week 1 to 8
  • A plaster cast is applied after surgery. No stretching or exercise, just let it heal.
  • You may be able to work the upper body. Try to do something positive, it will certainly help your state of mind.
Week 8 onwards

Stage 1- Range Of Motion And Flexibility
  • Place heal raises (1-2cm) in the shoes to take some of the pressure off the achilles tendon.
  • Sports massage techniques and ultrasound can aid in this process by helping to realign the new fibres in line with the tendon.
  • Active stretching. Pull your toes upwards to stretch the achilles tendon. Very gently at first and gradually build up.
  • If active stretches produce no pain then passive stretches can commence. This involves someone or something assisting in the stretching process.
  • When a full range of motion has returned (the ruptured leg is as flexible as the other leg) then a gradual strengthening programme can start.
  • Balance exercises should also be introduced as the sense of balance and positioning is often decreased after tendon or ligament ruptures and if not re-gained, can lead to future injuries. Wobble boards (balance boards) are great for this.
Stage 2 : Strengthen The Achilles Tendon And Calf Muscles
  • Great care must be taken when commencing a strengthening programme. There is a fine line between strengthening the tendon and re-injuring it.
  • You can start strengthening exercises as soon as they can be tolerated. It may be a full month after the cast comes off before exercises can begin.
  • The athlete may feel a little pain when you first start these exercises. If the pain is intolerable then do not continue. Gradually each day the pain should be less. The athlete should not attempt to increase the level of exercise until there is no pain during or after the exercises.
The strengthening exercises must be done after a gentle warm up and stretch. The muscles can be warmed up by raising the heels up and down on the toes while seated. Heat applied directly to the tendon for example by a hot water bottle can also help. Flexibility training must be continued throughout. Remember to ice after exercise, this will help keep inflammation down. Avoid explosive or ballistic movements or this may lead to a re-rupture.

Simple Stretching Exercises Pictures (Click on the picture to read description)
Simple Stretching Exercises Pictures (Click on the picture to read description)

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