Acute Achilles Tendon Ruptures
An acute rupture of the Achilles tendon is common and seen most frequently in people who participate in recreational athletics into their 30’s and 40’s. It is also a common injury in high-level athletes of any age.
The mechanism of injury is typically when one plants their foot and forcibly changes direction or jumps with a sudden contracture of their calf muscle causing rupture of an otherwise normal Achilles tendon. The most common sports leading to Achilles tendon rupture are what we refer to as “court sports and racquet sports”.
Common activities where ruptures occur:
Do I have an Achilles rupture?
Typically, the athlete feels a snap in their Achilles area and many feel that somebody was behind them and kicked them; but when they look behind them nobody is there.
Many people nearby, including the athlete, can hear the snap. Although, many patients do not seek medical attention immediately because they can walk on it and it is not as painful as one would think.
If one suspects that they may have a a rupture of their Achilles tendon, it is imperative to seek immediate medical attention. If one is walking on it and presents symptoms 72 hours after the time of injury, nonsurgical treatment may not be an option. Therefore, to become at least a candidate for nonsurgical treatment one must present immediately and be immobilized in a plantar flexion splint. The patients should be non-weightbearing until evaluated by a medical professional.
Testing and Diagnosis.
When you see a physician, a very simple test called a Thompson Test (squeeze test) is performed that is very helpful in determining a complete rupture of the Achilles tendon.
If you think you may be experiencing an Achilles rupture- you should complete the Thompson Test here, http://www.orthopaedicsone.com/display/Main/Thompson+test
One can often see a visible gap in the tendon as well. An MRI is rarely needed to make the diagnosis. Once the diagnosis is made, one should seek consultation with an orthopedic surgeon to go over the various options.
Treatment options include nonsurgical and surgical treatment.
There are some very strict protocols that must be adhered to when instituting nonsurgical management with what is called functional bracing, as well as time spent non-weightbearing, following with time weightbearing, and finally the start of early motion.
Surgery is often performed and can include percutaneous and many mini open techniques, as well as the classic open techniques. Open techniques carry the added risk of potential wound problems.
Recent studies have shown that surgical treatment provides earlier return to work and stronger plantar flexion strength compared to the nonsurgical approach. This is why surgical treatment is performed in most athletes.
Although it used to be felt that re-rupture rate were double that in nonsurgical management, with new protocols and functional bracing, re-rupture rates are very similar.
I think the athlete needs to be aware of the various options but should go with what the treating physician is most comfortable with. A physician may have many years of treating Achilles tendon ruptures the same way with minimal risk. If one is not comfortable with the first option, one should always obtain a second option. There is no absolute right or wrong way to manage these.
Basically, athletes can progressively train to return to function but are withheld from high level activities with a lot of planting and twisting for 9 months following the injury, or until they can do a single-limb heel rise test indicating return of the integrity of the Achilles tendon and calf muscle.
AUTHORS PREFERENCE: I have been treating Achilles ruptures in my
private practice for 28 years. I have always performed open surgical management of the Achilles. As opposed to what many pieces of educational material states, as a physician I have not had any infections in otherwise healthy athletes undergoing a repair for a primary acute Achilles tendon rupture, so I highly suggest consideration of surgical treatment.
– Dr. Martin Mankey
Foot and Ankle Specialist
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