HOW TO TREAT TORN ACHILLES TENDON

TORN ACHILLES TENDON
TREATMENT

It is the largest tendon in your body. It stretches from the bones of your heel to your calf muscles.
It is a springy band of tissue at the back of your ankle and above your heel.
It lets you point your toes toward the floor and raise up on your tiptoes.
overstretching of Achilles tendon can tear (rupture) it completely or just partially
peak age for Achilles tendon rupture is 30 to 40.

ACHILLES TENDON

Causes for ACHILLES TEAR

poor conditioning (exercising without warm up or stretches)
A previous ruptured Achilles tendon is at high risk of rupturing.
Achilles tendon injuries occur more often during sports that involve running, jumping, and sudden starts and stops — such as soccer, basketball and tennis
Overstretching of Achilles tendon mostly injures it
Obesity excess weight puts more strain on the tendon.
corticosteroids medications (either taken by mouth or injected near the tendon)
fluoroquinolone antibiotics (ciprofloxacin, levofloxacin) overuse.

Signs and Symptoms of TORN ACHILLES

The sudden feeling of having been kicked in the calf.
A “pop” sound and sudden sharp pain is heard on tearing.
swelling near the heel which gets worse during the day while working
An inability to bend the foot downward or "push off" the injured leg when walking
An inability to stand on the toes on the injured leg
Bone spurs on the heel bone

What is the procedure to diagnose an Achilles tendon rupture?

It is majorly done by physical exam and its extent is known by imaging tests.
Clinically torn Achilles presents with a palpable gap on palpation and increased ankles range of motion in upward direction(passive dorsiflexion)
lack of heel raise
a positive Thompson Test (physical exam) .

Physical test for TORN ACHILLES TENDON

The Thompson test helps confirm the diagnosis(calf squeeze test)
If Achilles tendon is torn, the foot won't move because calf muscle won't be connected to your foot

Imaging test for TORN ACHILLES TENDON

X ray depicting torn Achilles tendon

Plain X-rays of the foot will reveal swelling of the soft tissues around the ankle, other bone injury, or tendon calcification.

USG depicting torn Achilles tendon

USG test is done to document the injury and size of the tear and to determine partial tear.
USG is effective in identifying the location of a tear, gap between the torn ends of the tendon, and partial/complete rupture.

MRI depicting torn Achilles tendon

MRI is done when a diagnosis of tendon rupture is not obvious on USG and to assess for presence of any soft-tissue trauma or fluid collection.
More importantly, MRI can help detect presence of tendon thickening, bursitis, and partial tendon rupture.

Treatment of TORN ACHILLES TENDON

Treatment options for a torn Achilles tendon include surgical and nonsurgical approaches.
Decision is based on the severity of the rupture and the patient’s health status and activity level.

Non surgical Treatment

Brace to immobilize ankle joint

Nonsurgical method is recommended for patients who are older, less active, and have a higher risk for surgery and anesthetic.
Nonsurgical management involves application of a short leg cast to the injured leg, with the foot in a slightly downward flexed position.

Maintaining the ankle in this position helps bring the ruptured tendon ends closer together to allow them to heal.
The leg is placed in a cast for 6 to 10 weeks and no movement of the ankle is allowed.
Walking is allowed on the cast after a period of 4 to 6 weeks.
When the cast is removed, a small heel lift is inserted in the shoe to decrease the stress on the Achilles tendon for next 2 to 4 weeks.

Following this, physical therapy is recommended.

Physical Therapy

With nonsurgical treatment people must start early rehab with weight bearing exercises.

avoid extreme dorsal flexion (directing toe upwards using ankle) movement because it results into tendon weakness and functional deficit.
Calf Stretch, Heel Lifts, Heel Drops, Calf Stretches, Toe Lifts.

Surgical Treatment

Torn Achilles tendon should be surgically repaired in the first 48 hours it is quite important to have a full recovery.
If it gets too late, then too much scar tissue will be laid down, and the tendon will lose some extensibility.

Surgery is done in case of the young, healthy and active individuals.
For athletes, surgery is often the first choice of treatment.
Prior to surgery general edema reduction interventions are utilized (Rest, Ice, Compression, Elevation).
The Achilles tendon can be repaired surgically by either a percutaneous or open technique/ mini open technique.

OPEN TECHNIQUE

With the open technique, a physician makes an incision to allow for better visualization and approximation of the tendon.

PERCUTANEOUS REPAIR TECHNIQUE

With the percutaneous technique, the surgeon makes several small skin incisions to repair the tendon.
It is done by using multiple puncture wounds.
A suture is woven through the proximal (near) and distal (far) portions of the tendon via puncture wounds.
The suture is tied, bringing tendon ends into apposition in plantar flexion of the ankle.
Blindly passing the suture in percutaneous repair can cause a sural nerve injury.

MINI OPEN REPAIR TECHNIQUE

The mini-open repair technique is developed to minimize the complications such as post-op wound infection of open repair and sural nerve injury in percutaneous repair.
A small skin incision over the rupture site is made and subcutaneous soft-tissue is bluntly spread.
A device is introduced through the incision under the skin layer and the suture is passed from the external guide through the skin into the tendon and out to the opposite side.
Usually, 3 sutures are passed through the proximal(near) and distal (far) tendon ends. The device and the suture are pulled out for apposition of ruptured tendon ends, and the sutures are tied with the ankle in plantar flexed(toe facing downwards) position.

The advantages of a surgical approach over non surgical

a decreased risk of re-rupture
Patient can return to their original sporting activities (within a time), and most regain their strength and endurance

Post Surgery recovery for TORN ACHILLES TENDON

Early mobilization after repair is beneficial in terms of recovery and improved tendon strength.
According to the recent advances in rehab studies, full body weight bearing in 30° fixed plantar flexion (directing toe downwards using ankle) is started after surgery.
controlled ankle mobilization in free plantar flexion (directing toe downwards using ankle) is initiated after the 2nd post-op week.
Prolonged postoperative immobilization is not followed now.
removable braces are used to practice range of motion exercises.

Rehabilitation Protocol for TORN ACHILLES TENDON

Rehab during the first 6 months of injury is crucial.
Goal is to prevent re-rupture for the first 2 months of injury or surgery and to improve calf muscle strength for the next 1 month.
Returning back to previous physical activity is considered in last 3 months.

3 phases of rehab post injury/ surgery:-

Phase I :- lasts for first 3 weeks.

edema is controlled.
Patient is Progressively made to bear full body weight.

Phase II :- lasts for week 4th - 6th.

Patient is made to walk in Natural gait pattern.
Full ankle range of motion is restored.
strength in lower leg is restored.

Phase III :- lasts from 6th to 15th week

running is included in program.
Balance and Coordination exercises are included.
Patient Returns back to his sport and begins with his drills.

Complications of TORN ACHILLES TENDON

Decreased range of motion
Reduced strength in Calf muscle
Chances of re-rupture
Surgical complication like skin sloughing, wound infection, nerve damage, and scarring.

Measures to prevent ACHILLES TENDON INJURY

Wear shoes with good support that fit well.
Effective Warm up before playing.
Stretching after vigorous activity.
Stop exercising if you feel pain or tightness in the calf or heel.

David Beckham's ACHILLES INJURY

March 14th 2010, David Beckham completely tore his left Achilles tendon while playing for AC Milan in an Italian Series A game.
With torn Achilles injury, went Beckham's opportunity to represent England for the 4th time in the World Cup.
Beckham got his Achilles surgically repaired in Finland next day itself.
Beckham was surely well warmed-up at that time in the game, and he didn't had any fitness issue either !.
Actually, most Achilles ruptures happen suddenly without any cause.

Achilles

Myth's river – where his mother dipped him,

fished him,

a slippery golden boy – flowed on, his name on its lips.

Without him, it was prophesied, they would not take Troy.

Women hid him, concealed him in girls' sarongs;

days of sweetmeats, spices, silver songs . . .

but when Odysseus came, with an athlete's build, a sword and a shield,

he followed him to the battlefield,

the crowd's roar,

and it was sport, not war, his charmed foot on the ball . . .

but then his heel, his heel, his heel . . .

When the Achilles injury shattered Beckham's hopes of playing at the World Cup, Poet Laureate Carol Ann Duffy wrote, Beckham this poem.

Injuries are part of life, life must go on.

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