Achilles Tendon Rupture

A tear or rupture of the Achilles tendon may occur as an acute injury due to sudden strain on the tendon. In most cases, the patient will feel a sudden sharp pain and may even hear the tendon snap. Badminton and squash are two of the "favourite sports" for this type of injury. However, Achilles tendon rupture may develop gradually as a chronic injury due, for example, to the use of certain medications (cortisone), chronic overuse, or metabolic disorders (diabetes). The tear may be either partial or complete.

Diagnosis

A palpable and sometimes visible dent in the Achilles tendon region can be seen on examination. Standing on tiptoe is impossible or, if possible, results in intense pain. If a tendon injury is suspected, an ultrasound examination (sonography) should always be performed. Ultrasound allows a good assessment of the extent of damage. Additionally, an X-ray may be obtained to rule out bony injury. Magnetic resonance imaging (MRI) studies may be ordered if a more precise assessment of the tear is required.

Treatment

Surgical tendon repair is indicated for treatment of fresh complete Achilles tendon ruptures. Primary surgical treatment is also performed in cases in which conservative treatment has a poor prognosis or if the patient is a competitive athlete. Surgical access is obtained through an incision made in the skin directly over the Achilles tendon. The torn ends of the tendon are then sewn together using sturdy suture material. Reinforcement of the tear site may be necessary in some cases. This can be accomplished by different methods, for example, by weaving the Achilles tendon fibres with endogenous foot tendon fibres.
After surgery, weight-bearing on the foot must be reduced in accordance with the extent of the rupture and the stability of surgical tendon repair. This is accomplished by wearing a special shoe. Partial Achilles tendon ruptures and ruptures which cannot be repaired surgically due to unfavourable circumstances (severe illness or old age) are treated conservatively. In these cases, a special shoe is used to immobilise the foot in a downward, pointed toe position to allow the torn ends of the tendon to fuse and mend. The angle of the foot is then gradually reduced until the foot is back in the normal position. Subsequently, a cushioning heel pad is worn in the normal shoes until the Achilles tendon is completely healed and stable.