The Achilles tendon is the strongest in the body but can rupture, particularly in middle age. It happens when it is over-stressed and this often occurs during sports. The symptoms of Achilles rupture are significant immediate pain and a snapping sensation in the back of the heel, followed by swelling and decreased power on walking. If you think you have ruptured your tendon you should immediately attend your closest emergency department. The most reliable test for Achilles rupture is the calf squeeze. This is variously known as the Thompson or Simmonds test. The patient is put prone on a couch with both feet dangling free. The non injured calf is squeezed and the foot noted to move into plantar-flexion. The injured calf is squeezed. If the foot does not move at all then the Achilles is ruptured. If it does move than the Achilles is intact. Another, less specific, test is feeling for a dip or dent in the tendon.
The foot should be put into a 30 degree equinous backslab, front slab or boot immediately, and then sent to foot and ankle fracture clinic forthwith. It is not necessary to book an ultrasound scan or other imaging unless there has been other trauma which is a concern – e.g. bony ankle injury/ bony calcaneal injury etc. which would require an X-Ray.
Historically, treatment of Achilles tendon rupture was surgical, however with modern functional rehabilitation techniques it is possible to get a very good outcome without surgery. The results of functional rehabilitation have been shown to be the same as surgery with regards to the risk of re-rupturing the tendon.
Non-operative management has the benefit of eliminating surgical risks such as wound healing problems and infection which can be quite high.
We use a special boot called VACOped. A video showing its application can be found here http://foot.oped.com.au/vacoped/ The rehabilitation regime that we use can be found here.
It is very important to get the foot into a toe down (equinous) position as soon as possible after the rupture to give the best results for non-operative management.
Non-operative functional rehabilitation is a good option for most people. Click here to view the evidence.
Whilst most patients will choose to be managed non-operatively there are some people who do require surgery. The operation involves a small cut over the ruptured tendon and surgical repair with stitches of the tendon. Sometimes this is done through a minimally invasive technique depending on the reason for tendon repair.
All surgical procedures carry some risk. These risks are usually rare, but can include infection, bleeding, damage to surrounding structures such as tendons or nerves, numbness, dysfunction of foot, ongoing pain, unsightly scar, painful scar, wound healing problems, swelling. There is also a risk that the procedure does not work fully and that the patient is left with some ongoing symptoms.
There are also some medical risks to surgery such as a clot in the leg (DVT), clot in the lung (pulmonary embolus or PE). The general anaesthetic has rare risks of problems such as heart attack, stroke, chest infection and in extremely rare circumstances, death.
Click here to download the non-operative functional rehab protocol.
Click here to download the post-operative rehab protocol.