The Achilles tendon is the largest tendon in your body and is responsible for pushoff up to 10 times body weight. Surgery is a common treatment for chronic Aquilas tendinitis or complete rupture of the Achilles tendon. The Achilles tendon had connects the calf muscle to the heat. When the tendon tears or ruptures the variety of surgical techniques are available to repair the damage and restore the tendons function. Recent research that is done at Emory University Department of orthopedics have perfected the repair of the Achilles tendon. The procedure is generally involves making an incision in the back of your leg and stitching the torn tendon together using a technique developed and tested by Dr. Labib. Depending on the condition of the torn tissue the repair may be reinforced with other tendons. Surgical complications can include infection and warned healing problems. The repair performed at Emory allows the patient quick return to weight-bearing and function. Healing and return to full function may take up to four months.
The Achilles tendon is most commonly injured by sudden plantarflexion or dorsiflexion of the ankle, or by forced dorsiflexion of the ankle outside its normal range of motion. Other mechanisms by which the Achilles can be torn involve sudden direct trauma to the tendon, or sudden activation of the Achilles after atrophy from prolonged periods of inactivity. Some other common tears can occur from overuse while participating in intense sports. Twisting or jerking motions can also contribute to injury. Fluoroquinolone antibiotics, famously ciprofloxacin, are known to increase the risk of tendon rupture, particularly achilles.
Patients who suffer an acute rupture of the Achilles tendon often report hearing a “pop” or “snap.” Patients usually have severe pain the back of the lower leg near the heel. This may or may not be accompanied by swelling. Additionally, because the function of the Achilles tendon is to enable plantarflexion (bending the foot downward), patients often have difficulty walking or standing up on their toes.
If an Achilles tendon rupture is suspected, it is important to consult a doctor straight away so that an accurate diagnosis can be made and appropriate treatment recommended. Until a doctor can be consulted it is important to let the foot hang down with the toes pointed to the ground. This prevents the ends of the ruptured tendon pulling any farther apart. The doctor will take a full medical history, including any previous Achilles tendon injuries and what activity was being undertaken at the time the present injury occurred. The doctor will also conduct a physical examination and will check for swelling, tenderness and range of movement in the lower leg and foot. A noticeable gap may be able to be felt in the tendon at the site of the rupture. This is most obvious just after the rupture has occurred and swelling will eventually make this gap difficult to feel. One test commonly used to confirm an Achilles tendon rupture is the Thomson test. For this test the patient lies face down on an examination table. The doctor then squeezes the calf muscles; an action that would normally cause the foot to point like a ballerina (plantar flexion). When a partial rupture has occurred the foot’s ability to point may be decreased. When a complete rupture has occurred, the foot may not point at all. Ultrasound scanning of the Achilles tendon may also be recommended in order to assist with the diagnosis.
Non Surgical Treatment
Not every torn Achilles tendon needs an operation. Recent studies have shown that even a conservative treatment, i.e. immobilizingt the leg can lead to satisfactory healing successes. This requires, however, that the patient is fitted with a cast (immobilization splint) and/or a special boot for a period of approximately 6 – 8 weeks. After that, the boot must be worn during the day for about two more weeks. An intensive physiotherapy will start after about six weeks to train the calf muscles so that the initial coordination can be restored. Running training on flat ground can be started again after another 10 – 12 weeks. Studies show that the danger of a recurring torn tendon is higher after a conservative treatment opposed to an operative treatment. Depending on the type of treatment, about 10 – 15 percent of those affected can expect at some point to again suffer from a tear of the Achilles tendon. Moreover, in the non-operated cases, we see more often a significant permanent weakness of the footprint, particularly restricting the ability to participate in sports.
The patient is positioned prone after administration of either general or regional anesthesia. A longitudinal incision is made on either the medial or lateral aspect of the tendon. If a lateral incision is chosen care must be taken to identify and protect the sural nerve. Length of the incision averages 3 to 10 cm. Once the paratenon is incised longitudinally, the tendon ends are easily identifies. These are then re-approximated with either a Bunnell or Kessler or Krackow type suture technique with nonabsorbable suture. Next, the epitenon is repaired with a cross stitch technique. The paratenon should be repaired if it will be useful to prevent adhesions. Finally, a meticulous skin closure will limit wound complications. An alternative method is to perform a percutaneous technique, with a small incision (ranging from 2-4 cm). A few salient points include: the incision should be extended as needed, no self-retaining retractors should be used, and meticulous paratenon and wound closure is essential. Postoperatively the patient is immobilized in an equinous splint (usually 10-15) for 2 weeks. Immobilization may be extended if there is any concern about wound healing. At the 2-week follow-up, full weight bearing is permitted using a solid removable boot. At 6 weeks, aggressive physical therapy is prescribed and the patient uses the boot only for outdoor activity. At 12 weeks postoperatively, no further orthosis is recommended.