Physical Therapy Partial Achilles Tendon Rupture
The Achilles tendon forms a thick band joining your calf muscles to your heel. This tendon can be ruptured with rapid movements such as sprinting, lunging and jumping. There are two ways to treat patients who have ruptured their Achilles tendon, non-operative management in a splint or cast, and surgery. Multiple research studies have shown that both approaches have similar outcomes at one year when rehabilitation is started early. After this injury, dedicated rehabilitation of your core muscles, leg strength, balance and agility are essential for you to return to doing all of your regular activities.
The Achilles tendon is a strong bands of fibrous connective tissue that attaches the calf muscle to the heel bone. When the muscle contracts, the tendon transmits the power of this contraction to the heel bone, producing movement. The Achilles tendon ruptures because the load applied to it is greater than the tendon's ability to withstand that load. This usually occurs as a result of a sudden, quick movement where there is a forceful stretch of the tendon or a contraction of the muscles eg: jumping, sprinting, or pushing off to serve in tennis. This occurs most often in sports that require a lot of stopping and starting (acceleration-deceleration sports) such as tennis, basketball, netball and squash. The Achilles tendon is on average 15cm in length. Most ruptures occur 2-6cm above where the tendon inserts into the heel bone. This is the narrowest portion of the Achilles tendon and is also the area with the poorest blood supply. achilles tendon rupture is most common when the muscles and tendon have not been adequately stretched and warmed up prior to exercise, or when the muscles are fatigued. the Achilles tendon has a poor blood supply, which makes it susceptible to injury and slow to heal after injury. During exercise the amount of blood able to travel to the tendon is decreased, further increasing the risk of rupture. Most experts agree that there are no warning signs of an impending rupture. However, frequent episodes of Achilles tendonitis (tendon inflammation) can weaken the tendon and make it more susceptible to rupture.
When the Achilles tendon ruptures a loud bang or popping sound may be heard. The person may feel that they have been hit or kicked in the back of the lower leg and often they will look over their shoulder to see who or what has hit them. This is quickly followed by the sudden onset of sharp pain in the tendon and a loss of strength and function. If a complete rupture has occurred it may not be possible to lift the heel off the ground or point the toes. Often the degree of pain experienced, or lack of it, can be inversely proportional to the extent of the injury, ie a partial rupture may in fact be more painful than a complete rupture.
During the physical exam, your doctor will inspect your lower leg for tenderness and swelling. In many cases, doctors can feel a gap in your tendon if it has ruptured completely. The doctor may also ask you to kneel on a chair or lie on your stomach with your feet hanging over the end of the exam table. He or she may then squeeze your calf muscle to see if your foot will automatically flex. If it doesn't, you probably have ruptured your Achilles tendon. If there's a question about the extent of your Achilles tendon injury, whether it's completely or only partially ruptured, your doctor may order an ultrasound or MRI scan. These painless procedures create images of the tissues of your body.
Non Surgical Treatment
Treatment of the initial injury is with use of ice, elevation, and immobilization. If suspected you should contact your podiatrist or physician. Further treatment with continued immobilization, pain medication, or anti-inflammatory medications may be advised. If casted the foot is usually placed in a plantarflexed position to decrease the stretch on the tendon. As healing progresses the cast is changed to a more dorsiflexed position at the ankle. The casting processes can be up to 8 weeks or more.
Surgical techniques for rupture repair are varied but usually involve reapproximation of the torn ends of the Achilles tendon, sometimes reinforced by the gastrocsoleus aponeurosis or plantaris tendon. Open reconstruction is undertaken using a medial longitudinal approach. Studies indicate that patients who undergo percutaneous, rather than an open, Achilles tendon rupture repair have a minimal rate of infection but a high rate of sural nerve entrapment (16.7% of treated cases).