Achilles tendon problems are becoming more and more prevalent as the baby boomers age and yet try to remain as active as possible. The largest group of problems seems to be in slightly overweight males in a more sedentary job. The most common scenario is someone who works in an office all day and then has a period of intense physical activity requiring repetitive use of the Achilles tendon. This injury is therefore commonly seen in recreational basketball, tennis, jogging (especially with a lot of hills), and softball where there is a sudden explosive load to the Achilles tendon. The fact that many participants are rushed for time and therefore do not stretch adequately does not help the situation. “ Heel cord” stretches are a must before pursuing the above activities.

There are stages of Achilles tendon disease. Rather than complete rupture the tendon may develop a tendonitis. This is a fibrous thickening and swelling that may even have a palpable nodule in the tendon. When this occurs it may or may not be painful. When the tendon is painful and acutely inflamed it is a warning to rest and protect the tendon. If activities are continued requiring explosive contraction of the muscle, rupture of the tendon will most likely ensue. There are many different modalities to treat the tendonitis. These range from heel lifts, taping, and anti-inflammatory drugs to casting and physical therapy.

Once the tendon has ruptured it must be treated. Symptoms of rupture are the patient feeling or even hearing a sudden sharp snap, sudden pain as if they were kicked in the back of the calf, and loss of function. The ankle is usually swollen and the pain is diffuse. Therefore this injury can easily be misdiagnosed with potentially devastating consequences. Signs to look for are a positive Thompson test and palpable defect over the achilles tendon. The Thompson test is done with the patient lying on their stomach and the knee of the affected leg flexed. When the calf muscle is squeezed the foot should be down going (plantar flexing). If it is not then the Achilles tendon is probably ruptured.

There is still a great deal of controversy as to treatment of Achilles tendon ruptures. There are definite camps on whether to operate or not. Both groups can show excellent results with both types of treatment. The non-operative proponents cite the fact that comparable results can be obtained without surgery. The period of protection will generally be longer (6 to 8 weeks of immobilization). The patients appear to have a higher re-rupture rate of approximately 10-14%. They also appear to be slightly weaker than the operatively repaired group.

The proponents of operative treatment feel they are assured of a better repair with a re-rupture rate of about 2-3%. Generally the period of complete immobilization is shorter (3 to 4 weeks). The single greatest complication to surgery can be wound healing problems. The blood supply to the back of the leg is poor and if a wound fails to heal or becomes infected it may even require skin grafting to get it healed up. The chances of this are low (less than 5%). Certainly the treatment needs to be individualized according to patient expectations, demands, and their general overall health.