What is it?
You may be playing football, running for a bus, or just stepping off a curb awkwardly. You immediately hear a pop and feel like someone has kicked you. You then have pain at the back of the ankle and difficulty walking, you may have torn your Achilles.
What causes it?
Usually, patients have some wear and tear in the tendon before it tears but many patients have been completely without symptoms until it happens. One thing I am always looking out for is a tear in the calf muscle. Although it can present very much like an Achilles tear it is much less worrying and gets better by itself in a few weeks.
I ultrasound scan all Achilles injuries to be sure about the diagnosis and give you the most reliable information so that I can treat you accordingly.
How can I treat it?
There are two major issues when it comes to torn Achilles. The one we most commonly talk about is re-rupture when the tendon tears again during the healing process. Originally it was thought that by stitching the tendon we would reduce the risk of this but modern early rehabilitation has similar results with regard to re-rupture.
However, the other issue is the tendon healing long and being weak. It is for this reason that in active patients I still believe that surgery does have a role. I visited Swansea where they have the most developed Achilles management programme in the UK and have a very successful non-operative protocol. They scan all ruptures and operate when there is a tendon gap. In my experience, if you are diagnosed immediately and appropriately put in a cast with your toes down, there is a reasonable chance your Achilles will heal without any lengthening. If however, there is any delay in diagnosis there is a high chance that there will be a gap between the tendon ends.
If we decide on non-operative management, you spend 2 weeks in a cast with your toes down. I build wedges into the cast so you can walk on it and be more comfortable. You then go into a special boot and start therapy.
The boot remains on for around 8 weeks and therapy takes 3-4 months. Full recovery takes 6-9 months after this type of injury.
What does surgery involve?
If we decide on surgery, it is done as a daycase procedure. I make a small 3-4cm cut directly over the tear and inspect both ends of the damaged tendon. I then release the muscle below which bends the big toe. I do this without damaging the muscle or affecting its function. This muscle has an excellent blood supply and can help the Achilles heal. I then repair the Achilles and close the layer above it to protect the skin.
Aftercare is the same as nonoperative treatment but there is a better chance of a stronger tendon if there is any gap.
Risks and complications
There are risks to all surgery and conservative measures should be tried when possible. If surgery is an option, we will discuss all of the pros and cons and the risks that are specific to you in detail.
The main risk with Achilles surgery is wound problems. This is why I do the surgery through a small incision and repair the tendon covering sheath. This reduces friction and the risk of wound problems