The Achilles tendon connects the muscles in the back of your calf to your heel bone. There are two basic variations of Achilles injuries. Achilles tendonitis, and a complete tear. Its important to know whether the Achilles is torn or not, because the treatment is very different, a torn Achilles may require surgery. Achilles tendonitis probably means rehab and rest. While tendonitis is a gradual onset of pain that tends to get worse with more activity, an Achilles tear is a sudden injury, and it feels as if you were hit or kicked in the back of the ankle. A tear usually affects your ability to walk properly. Because an Achilles tendon rupture can impair your ability to walk, its common to seek immediate treatment. You may also need to consult with doctors specializing in sports medicine or orthopaedic surgery.
The cause of Achilles tendon ruptures besides obviously direct trauma, is multifactorial. In many instances the rupture occurs about 2-6 cm before its attachment to the calcaneous (heel bone). In this area there is a weaker blood supply making it more susceptible to injury and rupture. Rigid soled shoes can also be the causative factor in combination with the structure of your foot being susceptible to injury.
Symptoms of an Achilles tendon rupture include sensation that someone or something has hit the back of the calf muscle, sudden pain, pain when walking, weakness in the leg, which is particularly noticeable when trying to push off while walking and there is not sufficient strength to do so.
Your caregiver will ask what you were doing at the time of your injury. You may need any of the following. A calf-squeeze test is used to check for movement. You will lie on your stomach on a table or bed with your feet hanging over the edge. Your caregiver will squeeze the lower part of each calf. If your foot or ankle do not move, the tendon is torn. An x-ray will show swelling or any broken bones. An ultrasound uses sound waves to show pictures of your tendon on a monitor. An ultrasound may show a tear in the tendon. An MRI takes pictures of your tendon to show damage. You may be given dye to help the tendon show up better. Tell the caregiver if you have ever had an allergic reaction to contrast dye. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell the caregiver if you have any metal in or on your body.
Non Surgical Treatment
Pain medicines can help decrease pain and swelling. A cast may be needed for 2 months or more. Your foot will be positioned in the cast with your toes pointing slightly down. Your caregiver will change your cast and your foot position several times while the tendon heals. Do not move or put weight on your foot until your caregiver tells you it is okay. A leg brace or splint may be needed to help keep your foot from moving while your tendon heals. Heel lifts are wedges put into your shoe or cast. Heel lifts help decrease pressure and keep your foot in the best position for your tendon to heal. Surgery may be needed if other treatments do not work. The edges of your tendon may need to be stitched back together. You may need a graft to patch the tear. A graft is a piece of another tendon or artificial material.
Surgical correction of the ruptured tendon is almost always necessary. Surgery is performed in order to regain the maximum strength of the Achilles, as well as the normal pushing off strength of the foot. The strength of the muscle depends on the correct tension between the muscle and the tendon. The only way the correct tension on the tendon can set is by accurately repairing the tendon ends. When the tendon ruptures, the ends of the tendon separate and multiple little strands of the tendon are present like pieces of spaghetti. There are old fashioned techniques for repairing the tendon which require very long incisions (eight inches) on the back of the leg. These are complicated and associated with a high incidence of infection in the skin after surgery. This is an important consideration, since infection in the skin can lead to devastating problems with the skin and tendon. This problem of skin infection has, in the past, led surgeons away from surgical methods of treatment. Fortunately, now there is a new, unique method available for operating on and repairing the tendon. This new method requires only a tiny incision of one to two centimeters in length. This is far more accurate surgery. Recovery after this procedure is easier and the surgical complication rate is extremely low.
The best treatment of Achilles tendonitis is prevention. Stretching the Achilles tendon before exercise, even at the start of the day, will help to maintain ankle flexibility. Problems with foot mechanics can also lead to Achilles tendonitis. This can often be treated with devices inserted into the shoes such as heel cups, arch supports, and custom orthotics.