Achilles Tendon Rupture
What is an Achilles Tendon Rupture?
The Achilles tendon is a strong, thick, and important structure that functions to bring the ankle and foot downwards and propel the body forward in gait. Thousands of fibrous bands of tissue bind together to form the dense Achilles. The calf muscle (gastrocnemius) becomes the Achilles tendon about midway in the lower leg. The tendon travels down the back of the leg, crosses the ankle, and attaches to the top and back of the heel bone (calcaneus). The Achilles tendon acts as a “rubber band” that stretches back and forth with each step.
If there is a force too strong for the tendon to handle the tendon can tear or rupture.
Left untreated, a rupture or partial tear of the Achilles can be chronically painful and become Achilles Tendinosis.
What are the Symptoms of an Achilles Tendon Rupture?
At the time that an Achilles tendon rupture occurs, many patients will relate a story like this: “I felt as if someone had kicked me in the back of the leg and I looked around and no one was around.” Patients will complain of an initial “snap” and sharp stabbing pain in the back of the lower leg followed by a relief of pain. Walking will be difficult but not impossible. The patient will notice that they cannot push the ankle and foot downwards as easily, cannot go up onto the toes, have difficulty using stairs, and have difficulty performing activities. There will be significant bruising and swelling around the ankle and back of the lower leg.
After the initial decrease in pain, if immediate attention is not given to the injury, patients will complain of a deep achy pain, and sometimes a sharp knife like pain. The pain is more pronounced with attempted walking and activities.
What Causes an Achilles Tendon Rupture?
Any motion that demands the use of the Achilles tendon when it is not ready to be elastic can result in a rupture of the Achilles. A sudden movement from a stationary position to running or jumping can lead to a tendon rupture. A tear can occur when jumping then landing onto the ball of the foot and the heel is forced quickly to the ground.
Patients with an Achilles tendinosis have a higher risk of a rupture of the tendon. Those that may have been given 1 or more cortisone injections into the tendon are at higher risk of a rupture of the Achilles tendon. Patients that are born with, or acquire over time, a muscle/tendon complex that is too short (equinus), have a higher risk of a rupture during an activity. It is seen in women and men, athletes and non-athletes.
How is an Achilles Tendon Rupture diagnosed?
Diagnosis is achieved by the clinical examination, and a diagnostic ultrasound of the patient. Dr. Soomekh will listen to the patient’s complaints, symptoms, and goals. The examination involves a hands-on analysis of the patient’s foot and ankle and an evaluation of their gait. There will be special examination of the Achilles tendon and its muscle to determine the degree of the Achilles tendon rupture. A void will be felt along the course of the tendon at the level of the tear.
Dr. Soomekh may evaluate the tendon using a state-of-the-art diagnostic ultrasound. This examination, performed in the office, can show the tear and the degree of injury.
An MRI will be ordered in order to determine the amount of separation between the ends of the Achilles tendon tear.
How is an Achilles Tendon Rupture Treated?
Dr. Soomekh educates that early diagnosis and treatment of Achilles Tendon Rupture is the key to successful treatment, faster recovery and painless lifestyle.
Conservative Treatment for Achilles Tendon Rupture:
Conservative treatment for an Achilles rupture is limited to a small number of cases. Conservative treatments rely on their ability decrease pain, reduce inflammation, and facilitate healing of the ruptured ends of the tendon. Success of conservative treatment is determined by the degree of rupture, distance of separation between the ends of the tendon, and quality of the tear. Dr. Soomekh will place the patient in a cast with the ankle in a fully down flexed position to bring the ends of the tendon as close together as possible. The patient will not be able to bear weight on the affected foot for a period of 6 to 12 weeks. Reduction of the inflammation and pain can be achieved by treating the area with a daily regimen of ice therapy and the use of anti-inflammatory medications (NSAID’s). If the tendon heals, there will be a period of time walking in a walking boot for up to 6 weeks. The re-rupture rate with conservative treatment is significantly high.
Surgical treatment for Achilles Tendon Rupture:
Dr. Soomekh will always recommend and attempt conservative treatment when appropriate. However, in the case of Achilles tendon rupture, surgical correction is indicated in most cases.
Is Achilles Tendon Surgery Painful?
Considering surgery can be intimidating. Ankle surgery including Achilles tendon surgery is not supposed to be painful during recovery. When the skin and the soft tissues are handled with care and focus, most patients experience little to no pain immediately after surgery and throughout the recovery period. Dr. Soomekh takes great care and focus to minimize the chance of postoperative pain. The goal of Achilles tendon surgery is to remove scar tissue and damaged tendon, repair the tendon, alleviate pain, allow a return to normal shoes, and allow a return to all activities. Dr. Soomekh performs Achilles tendon repairs in an outpatient setting at state of the art facilities.
Percutaneous Repair of Achilles Tendon Rupture
The Percutaneous Achilles Repair System (PARS) is a minimally invasive surgical repair. It requires a small incision placed over the ruptured part of the tendon. Using a special “jig” several high tensile stitches are passed through skin and into the tendon ends. Theses stitches are then tied to one another bringing the ends of the tendon together. The patient will be in a cast non-weight bearing with crutches for 4 to 6 weeks. Physical therapy is integral in rehabilitating the muscle and tendon. Custom molded orthotics are recommended when activity begins again. The procedure is performed in an outpatient setting.
Open Repair of Achilles Tendon Rupture
In many cases, the amount of tendon disruption warrants an open surgical correction. An incision is made on the back of the leg along the course of the Achilles tendon over the ruptured area. Once the tendon is exposed, portions of damaged tendon and tissue are removed. Specialized stitches are placed within both ends of the tendon. The ends of the tendon are then brought together and the stiches are tied. In most cases, Dr. Soomekh chooses to enhance the repair to give the tendon the best opportunity to heal with strength and less scar tissue. This can be done in a few different ways. Platelet Rich Plasma (PRP) mixed with stem cells with Bone Marrow Aspiration, (BMA) can be wrapped around the tendon. A special graft material can get wrapped around the tendon. Amniox™ regenerative tissue can be wrapped around the tendon. The skin is then closed using plastic surgery techniques. The procedure will require 4 to 6 weeks in a cast and crutches with no weight bearing. Physical therapy is integral in rehabilitating the muscle and tendon. Custom molded orthotics are recommended when activity begins again. The procedure is performed in an outpatient setting.
Dr. Soomekh has perfected and reinvented these surgical procedures and techniques and is recognized by his peers as one of the top Achilles tendon specialists and Achilles surgeons in Los Angeles.