Achilles heel tear: Achilles tendon rupture – Symptoms and causes
Achilles Tendon Tear | FootCareMD
What is an Achilles tendon tear?
The Achilles tendon is a large tendon at the back of the lower leg and ankle that connects the calf muscles to the heel. It is the largest tendon in the body, and its strength allows us to push off with forces up to 10 times our body weight.
An Achilles tendon tear, or rupture, usually is a complete gap between the upper and lower portions of this tendon. It most often occurs 2-3 inches above the heel bone but can be directly at the attachment or higher in the leg.
A tear usually occurs during activities such as running and jumping, or trauma such as a slip and fall. Most patients report their first feeling was a “pop” or like they were struck in the back of the ankle, followed by some pain. There often is no pain
in this area before the actual tear. After the tear, patients complain of weakness when pushing off of their foot during walking or when trying to stand on tiptoe. There may be a small bruise on the inside of the heel during the first few days.
Your foot and ankle orthopaedic surgeon often performs an examination
to make a diagnosis. You will lie in a facedown position with your ankles off the edge of the exam table. When the Achilles tendon is not torn, it is taut and the ankle lies in a toe down position of approximately 20 degrees. Squeezing the upper calf
will cause the toes to point down even further.
If the tendon is torn, it does not have this tension and the ankle usually will hang at about a 90-degree angle. Squeezing the upper calf will cause weak or no movement. Your surgeon will lightly pinch the Achilles tendon 2-3 inches above the heel to
determine if there is a gap. Special tests such as ultrasound, X-rays, and MRI scans typically are not helpful but can be in some instances.
At first, the leg is placed at rest in a splint or special boot. It is important to see a foot and ankle orthopaedic surgeon soon after the injury so the best treatment can be started within a few days.
Both non-surgical and surgical treatments have been well studied but remain debated. In general, surgical treatment is thought to give greater strength and result in a lower risk of repeat tear. However, surgery has an increased risk of wound healing
problems, nerve damage, and infection plus the usual risks associated with surgery. Blood clots are a concern with both types of treatment. Your foot and ankle orthopaedic surgeon will be the best person to guide you through the pros and cons and
help you to select the best option.
Non-surgical treatment starts with a period of rest in a brace for the injured leg. You will need to use crutches, a walker, or wheelchair in order to not put weight on the leg. Within the first few weeks you will start doing active motion. The brace will be adjusted over time as the Achilles tendon
heals to allow increased movement. Gradually, you will be allowed to put weight on the leg and start specific strengthening exercises. The length of treatment may be different for each patient but usually takes about three months. It is often guided
by a physical therapist along with the orthopaedic surgeon.
In this surgery, your foot and ankle orthopaedic surgeon
will place stitches into the tendon above and below the area of the tear and then pull the ends together. This is because the actual tear appears similar to two wet mops with multiple uneven strands that need to be brought together. The stitches can
be applied through one or more incisions (viewing the tendon directly) or through multiple small incisions (placing the sutures through the tendon using a guide). The recovery after surgery is similar to the non-surgical treatment but can be slightly
Since tendons do not have a great blood supply, healing is a slow process. Patients usually can start light jogging in 3-6 months with return to sports involving cutting and jumping in 6-9 months. Full return of strength and the feeling of being normal
may take more than a year.
Is there anything I can do to prevent tearing the Achilles tendon?
Achilles tendon tears occur so rarely that there is no study that really answers this question well. A stretching program for the Achilles tendon makes sense but
the benefit has not been well shown. That being said, there is no downside to stretching the tendon and it should be part of every athlete’s warm up. Smoking should be avoided as the negative effects of cigarettes on tendon health have been well shown.
After an Achilles tendon tear, how likely am I to tear the other side?
About 6% of patients with an Achilles tendon tear will have the same injury in the other foot.
Is there anything I can do to make the tendon heal faster?
Starting range-of-motion exercises and putting weight on the injured leg early have shown better results than long periods of immobilization on crutches. However, it has
to be balanced by the risk of pulling apart the ends of the tendon if you stretch too much too early. Stopping smoking for at least a few months while the tendon heals also is likely to be of benefit.
Original article by F. Ray Nickel, MD
Last reviewed by Wen Chao, MD, 2020
The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images, and graphics, is for informational purposes only. The content is not intended to substitute
for professional medical advice, diagnoses or treatments. If you need medical advice, use the “Find a Surgeon” search to locate a foot and ankle orthopaedic surgeon in your area.
Achilles Tendon Rupture – Foot Health Facts
What Is the Achilles Tendon?
A tendon is a band of tissue that connects a muscle to a bone. The Achilles tendon runs down the back of the lower leg and connects the calf muscle to the heel bone. Also called the heel cord, the Achilles tendon facilitates walking by helping to raise the heel off the ground.
What Is an Achilles Tendon Rupture?
An Achilles tendon rupture is a complete or partial tear that occurs when the tendon is stretched beyond its capacity. Forceful jumping or pivoting, or sudden accelerations of running, can overstretch the tendon and cause a tear. An injury to the tendon can also result from falling or tripping.
Achilles tendon ruptures are most often seen in “weekend warriors”—typically, middle-aged people participating in sports in their spare time. Less commonly, illness or medications, such as steroids or certain antibiotics, may weaken the tendon and contribute to ruptures.
Signs & Symptoms
A person with a ruptured Achilles tendon may experience one or more of the following:
- Sudden pain (which feels like a kick or a stab) in the back of the ankle or calf—often subsiding into a dull ache
- A popping or snapping sensation
- Swelling on the back of the leg between the heel and the calf
- Difficulty walking (especially upstairs or uphill) and difficulty rising up on the toes
These symptoms require prompt medical attention to prevent further damage. Until the patient is able to see a doctor, the RICE method should be used. This involves:
- Rest. Stay off the injured foot and ankle, since walking can cause pain or further damage.
- Ice. Apply a bag of ice covered with a thin towel to reduce swelling and pain. Do not put ice directly against the skin.
- Compression. Wrap the foot and ankle in an elastic bandage to prevent further swelling.
- Elevation. Keep the leg elevated to reduce the swelling. It should be even with or slightly above heart level.
In diagnosing an Achilles tendon rupture, the foot and ankle surgeon will ask questions about how and when the injury occurred and whether the patient has previously injured the tendon or experienced similar symptoms. The surgeon will examine the foot and ankle, feeling for a defect in the tendon that suggests a tear. Range of motion and muscle strength will be evaluated and compared to the uninjured foot and ankle. If the Achilles tendon is ruptured, the patient will have less strength in pushing down (as on a gas pedal) and will have difficulty rising on the toes.
The diagnosis of an Achilles tendon rupture is typically straightforward and can be made through this type of examination. In some cases, however, the surgeon may order an MRI or other advanced imaging tests.
Treatment options for an Achilles tendon rupture include surgical and nonsurgical approaches. The decision of whether to proceed with surgery or nonsurgical treatment is based on the severity of the rupture and the patient’s health status and activity level.
Nonsurgical treatment, which is generally associated with a higher rate of rerupture, is selected for minor ruptures, less active patients and those with medical conditions that prevent them from undergoing surgery. Nonsurgical treatment involves use of a cast, walking boot or brace to restrict motion and allow the torn tendon to heal.
Surgery offers important potential benefits. Besides decreasing the likelihood of rerupturing the Achilles tendon, surgery often increases the patient’s push-off strength and improves muscle function and movement of the ankle.
Various surgical techniques are available to repair the rupture. The surgeon will select the procedure best suited to the patient.
Following surgery, the foot and ankle are initially immobilized in a cast or walking boot. The surgeon will determine when the patient can begin weightbearing.
Complications such as incision-healing difficulties, rerupture of the tendon or nerve pain can arise after surgery.
Whether an Achilles tendon rupture is treated surgically or nonsurgically, physical therapy is an important component of the healing process. Physical therapy involves exercises that strengthen the muscles and improve range of motion in the foot and ankle.
Achilles Tendon Injuries | Cedars-Sinai
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What are Achilles tendon injuries?
The Achilles tendon is a fibrous
band of tissue that links the muscles in your calf to your heel. The strength and
flexibility of this tendon are important for jumping, running, and walking. Your
Achilles tendon bears a lot of stress and pressure during everyday activities, as well
as during athletic and recreational play. If it becomes inflamed, swollen, and
irritated, it is called tendonitis.
What causes Achilles tendon injuries?
Achilles tendon injuries can be caused by the following:
Tendonitis might be due to overuse or damage to the area. It can cause pain down the back of your leg and around your heel. You might notice that parts of your tendon are getting thicker, and hardening, because of tendonitis. This will get worse if you don’t treat it. There are 2 main types of tendonitis:
- Non-insertional Achilles tendonitis. Small tears in the middle fibers of your tendon start to break it down. This causes pain and swelling. This type of tendonitis usually affects active, younger adults.
- Insertional Achilles tendonitis. This damage occurs in the spot where your tendon meets your heel bone. Bone spurs (extra bone growth) often form with this type. This type of tendonitis can happen at any age, even in people who are not active.
The tears in your tendon fibers can cause a complete or partial break (or tear) in your tendon. You might hear a “pop” that seems to come from the back of your heel or calf. This may be a tendon rupture, which needs immediate medical attention.
Who is at risk for Achilles tendon injuries?
Anyone can develop an Achilles tendon injury. They’re often linked to repetitive stress. The most common risk factors are:
- Increased amount or intensity of an activity or sport
- Starting a new sport
- Tight calf muscles when starting an exercise or sport, this can place more stress on your tendon
- Bone spurs on your heel, which can rub against the tendon
- Wearing the wrong shoes when you exercise
- Exercising on an uneven surface
- Treatment with fluoroquinolone, an antibiotic
What are the symptoms of an Achilles tendon injury?
Common symptoms of tendon injuries include:
- Pain down the back of your leg or near your heel
- Pain that gets worse when you’re active
- A stiff, sore Achilles tendon when you first get up
- Pain in the tendon the day after exercising
- Swelling with pain that gets worse as you’re active during the day
- Thickening of your tendon
- Bone spurs on the heel bone
- Difficulty flexing the affected foot
- A “pop” sound and sudden sharp pain,
which can mean a ruptured tendon
How is an Achilles tendon injury diagnosed?
Injury to the Achilles tendon causes pain along the back of your leg near the heel. Sometimes healthcare providers misdiagnose Achilles tendon injuries as a sprained ankle. It’s important to get the right diagnosis so you can get the right treatment. Several common injuries can make your Achilles tendon painful or prevent it from working well.
Your healthcare provider will
consider the following when making a diagnosis:
- Your overall health and medical history
- A description of your symptoms
- A physical exam of your Achilles tendon to check for bone spurs, pain, and swelling
- A test to see if you can move your
ankle properly (range of motion)
- Imaging tests, such as X-ray or MRI.
An X-ray shows bones and can show if the tendon has become calcified or hardened, and
can show bone spurs. Your healthcare provider will usually use MRI to see how severe
the tendon damage is and what treatment is best for you.
How are Achilles tendon injuries treated?
Treatment depends on how badly injured your tendon is. It may include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief such as ibuprofen or naproxen
- Specific exercises to strengthen your calf muscles
- Physical therapy
- A type of exercise that helps strengthen your calf muscles to take pressure off your tendon called eccentric strength training
- Low-impact activities, such as swimming
- Heel lifts in shoes, orthotic shoes, cast, splint, or a walking boot
- Extracorporeal shockwave therapy. This treatment uses high-energy shockwave impulses to help stimulate the healing process in damaged tendon tissue. This treatment isn’t often used. However, your healthcare provider may recommend it to see whether you can improve without surgery
If these treatments do not work, or if the injury is severe or complete, surgery may be considered. The type of surgery depends on the location and amount of damage to the tendon. It can also depend on other things, such as the severity of the tendonitis. Some of the surgical procedures used include:
- Surgery to lengthen your calf muscles (gastrocnemius recession)
- Debridement surgery to remove damaged tendon tissue or bone spurs and repair the tendon
- Surgery to remove your damaged tendon tissue, fix the remaining tendon, and give it extra strength by moving another tendon to the heel bone
What are possible complications of Achilles tendon injuries?
Complications of an Achilles tendon injury may include:
- Pain, which can be severe
- Difficulty walking or being active
- Warping of your tendon area or heel
- Tendon rupture from re-injury
Other complications can happen
because of the treatments used to treat an Achilles tendon injury. For instance:
- Sometimes, cortisone injections can
cause the tendon to tear
- Surgery can lead to pain and infection
How can I prevent Achilles tendon injuries?
These steps can help prevent injury to your Achilles tendon:
- Warm up before exercising or before sports or other repetitive movements.
- Increase activity slowly, rather than all at once.
- Wear the correct shoes for your activities.
- Do not exercise on uneven surfaces.
- Stop activities that cause pain.
- Be aware of the risks of fluoroquinolone and exercise with caution if you’re taking this drug.
How to manage an Achilles tendon injury
- Follow your healthcare provider’s
advice to get rest and manage pain and swelling.
- Choose other ways to be active.
- Try low-impact activities that do not place a lot of stress on your tendon, such as swimming or bicycling, rather than a high-impact exercise like running.
- Always let your healthcare provider
know if these strategies don’t help reduce pain, swelling, and loss of function.
When should I call my healthcare provider?
Call your healthcare provider right
away if you hear a “pop” sound and have sudden pain in the back of your leg or heel.
Otherwise, schedule an appointment if pain or trouble moving affects your regular daily
Key points about Achilles tendon injuries
- Your Achilles tendon can develop tendonitis. This is when it becomes inflamed, swollen, and irritated.
- The Achilles tendon can also tear or rupture, which might sound like a “pop” that seems to come from the back of your heel or calf. This needs immediate medical attention.
- Anyone can develop an Achilles tendon injury and it’s often linked to repetitive stress on the tendon.
- Achilles tendon injuries often cause pain, stiffness, and swelling in the back of your leg near your heel.
- Achilles tendon injuries can be treated with rest and medicines to help with the inflammation. Exercises often help too. If needed, surgery can be done to repair the tendon.
- You can help prevent these injuries by doing things like increasing activity slowly, wearing the correct shoes for your activities, and not exercising on uneven surfaces.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.
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Achilles Tendon Problems | Michigan Medicine
What is the Achilles tendon?
The Achilles tendon connects the calf muscle to the heel bone. It lets you rise up on your toes and push off when you walk or run.
What are common Achilles tendon problems?
The two main problems are:
- Achilles tendinopathy. This refers to tiny tears (microtears) in the tissue in and around the tendon. These tears are caused by overuse. Achilles tendinopathy is also often called Achilles tendinitis.
- Achilles tendon tear or rupture. An Achilles tendon also can partially tear or completely tear (rupture). A partial tear may cause mild or no symptoms. But a complete rupture causes pain and sudden loss of strength and movement.
Problems with the Achilles tendon may seem to happen suddenly. But usually they are the result of many tiny tears in the tendon that have happened over time.
Achilles tendinopathy is likely to occur in men older than 30. Most Achilles tendon ruptures occur in people 30 to 50 years old who are recreational athletes (“weekend warriors”). Ruptures can also happen in older adults.
What causes Achilles tendon problems?
Achilles tendinopathy is most often caused by overuse or repeated movements during sports, work, or other activities. For example, if you do a lot of pushing off or stop-and-go motions when you play sports, you can get microtears in the tendon.
Achilles tendon rupture is most often caused by a sudden, forceful motion that stresses the calf muscle. This can happen during an intense athletic activity or even during simple running or jumping. Middle-aged adults are especially likely to get this kind of injury.
What are the symptoms?
Symptoms of Achilles tendinopathy include swelling in the ankle area and mild or severe pain. The pain may come on gradually or may only occur when you walk or run. You may have less strength and range of movement in the ankle.
Symptoms of an Achilles tendon rupture may include a sudden, sharp pain. Most people feel or hear a pop at the same time. Swelling and bruising may occur. You may not be able to point your foot down or stand on your toes.
How are Achilles tendon problems diagnosed?
Your doctor can tell if you have an Achilles tendon problem by asking questions about your past health and checking the back of your leg for pain and swelling.
If your symptoms are severe or don’t improve with treatment, your doctor may want you to get an X-ray, ultrasound scan, or MRI.
How are they treated?
Treatment for mild Achilles tendon problems includes rest, over-the-counter pain medicine, and stretching exercises. You may need to wear well-cushioned shoes and change the way you play sports so that you reduce stress on the tendon. Early treatment works best and can help prevent more injury. Orthotic shoe devices can also help reduce stress on the tendon.
Even in mild cases, it can take weeks to months of rest for the tendon to repair itself. It’s important to be patient and not return too soon to sports and activities that stress the tendon.
Treatment for severe problems, such as a torn or ruptured tendon, may include surgery or a cast, splint, brace, walking boot, or other device that keeps the lower leg and ankle from moving. Exercise, either in physical therapy or in a rehab program, can help the lower leg and ankle get strong and flexible again. The tendon will take weeks to months to heal.
Although treatment for Achilles tendon problems takes time, it usually works. Most people can return to sports and other activities.
Achilles tendinopathy is most often caused by:
- Overuse or repeated movements during sports, work, or other activities. In sports, a change in how long, intensely, or often you exercise can cause microtears in the tendon. These tears are unable to heal quickly and will eventually cause pain. A change in your environment, such as going from a flat surface to a hill or from a dirt road to a paved road, can also cause these tears.
- Injury from repeated push-offs or a stop-and-go motion. These injuries are common in such activities as running, basketball, tennis, or ballet dancing.
Achilles tendon rupture is most often caused by:
- Sudden, forceful motion that stresses the calf muscle. This can happen during an intense athletic activity or even during simple running or jumping, especially in middle-aged adults. A rupture most often occurs in sports such as basketball, racquet sports (including tennis), soccer, and softball.
- Overstretching the tendon during any activity when the tendon is already damaged because of Achilles tendinopathy or another condition.
Symptoms of Achilles tendinopathy may include:
- Pain in the back of the heel, in the Achilles tendon area. Pain may be mild or severe. Swelling may occur.
- Tenderness in the Achilles tendon area. Tenderness may be more noticeable in the morning.
- Stiffness that goes away as the tendon warms up with use.
- Decreased strength and movement, or a feeling of sluggishness in the leg.
Symptoms of an Achilles tendon rupture may include:
- A sudden, sharp pain that feels like a direct hit to the Achilles tendon. There may be a pop when the rupture occurs. This may be followed by swelling and bruising.
- Heel pain. (It may be severe.)
- Not being able to go on tiptoe with the hurt leg.
If you have a partial rupture (tear) of the Achilles tendon, you may have near-normal strength and less pain after the initial injury, compared to what you would have after a complete rupture.
Achilles tendinopathy starts with repeated small tears in the tendon. These tears may cause no obvious symptoms. Or they may cause mild to severe pain during movement. As the tearing continues, the leg may weaken and the tendon pain may become constant. Abnormal growths (nodules) may form in the tendon, and it may thicken.
Without rest and treatment of Achilles tendinopathy, you may develop long-lasting (chronic) pain.
Achilles tendon tear or rupture
An Achilles tendon can partially tear or completely tear (rupture). A tear usually occurs in the tendon about 1.5 in. (3.8 cm) to 2.5 in. (6.4 cm) above where it attaches to the heel bone. Some doctors believe that this area is most likely to tear or rupture because of a limited blood supply.
If you don’t treat an Achilles rupture, you will feel weakness in your first steps when you walk. It may feel like walking in the sand. Over time, walking will become difficult.
Other Achilles tendon problems
Other conditions can affect the Achilles tendon area. These other conditions are caused by inflammation. They include:
What Increases Your Risk
Things that increase your risk for Achilles tendinopathy or rupture include:
- Sports and physical activity. Overuse and repeated movements can cause injury and weaken the Achilles tendon. Playing sports increases the risk of an injury. Activities at work (such as in construction) and at home (such as gardening) may also increase your risk.
- Sports training errors. Not warming up before running or other activities or suddenly changing your training program can increase your risk for injury. Increasing your distance, running uphill more often, or changing your ground surfaces too quickly can increase your risk. Decreased flexibility may also increase the risk of tendon problems.
- Age. Most cases of Achilles tendinopathy or rupture occur in people older than 30.
- Weight. If you are very heavy, you have a greater risk.
- Being male. Men are more likely than women to have an Achilles tendon injury.
- Footwear. You may increase your risk if you wear shoes that are worn out, that do not support your feet, or that do not cushion your heel.
Other risk factors for an Achilles tendon rupture include:
- A previous injury or rupture to the Achilles tendon.
- Corticosteroid injections in the Achilles tendon. They can weaken the tendon.
- Long-term use of quinolone antibiotics. Quinolones include ciprofloxacin and ofloxacin.
- Having osteoarthritis, gout, or rheumatoid arthritis.
When should you call your doctor?
Call your doctor right away if you think you have an Achilles tendon problem (at or above the back of your ankle) and:
- The back of your heel and ankle are very painful.
- You felt a sharp pain like a direct hit to the Achilles tendon.
- You heard a pop in your Achilles tendon when you were injured.
- You aren’t able to walk comfortably.
- Your Achilles tendon area has begun to swell.
- You have signs of damage to the nerves or blood vessels. Signs include numbness, tingling, a pins-and-needles feeling in your foot, and pale or bluish skin.
If you have had an Achilles tendon injury in the past and you have reinjured your Achilles tendon, call your doctor to find out what you need to do. Rest your lower leg and foot until treatment begins.
Watchful waiting is a period of time during which you and your doctor observe your symptoms or condition without using medical treatment. Watchful waiting is not a good idea if you have severe pain in the Achilles tendon area. If you think you have injured your Achilles tendon, call your doctor. Early treatment is most effective.
If you think you have Achilles tendinopathy and you have mild symptoms, rest your lower leg and foot for a couple of days. Follow the other steps in Home Treatment. If you have weakness, cramping, or constant pain in your Achilles tendon, call your doctor.
Who to see
Health professionals who can diagnosis and treat an Achilles tendon problem include:
You may be referred to a physical therapist for exercises to rebuild strength in your Achilles tendon and leg muscles.
Exams and Tests
Most doctors diagnose an Achilles tendon problem through a medical history and physical exam. This includes checking for tenderness, watching how you walk and stand, and comparing the range of motion of your two legs.
Other tests may be done to clarify a diagnosis or to prepare for surgery. These tests include:
- Ultrasound. It may be used to check whether there is a rupture of the tendon or signs of tendinopathy.
- X-rays, to check the heel bone.
- MRI scan to check the tendon for signs of tendinopathy or a tendon rupture. An MRI is also used to evaluate the heel bone.
Early treatment usually results in better healing.
To treat Achilles tendinopathy:
- Use home treatment. This includes resting your lower leg and foot, stretching the area, wearing cushioned shoes or other orthotics, and switching sports or modifying how you do sports that may have caused the problem.
- Reduce pain by using ice or taking over-the-counter pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), as directed. Be safe with medicines. Read and follow all instructions on the label.
- Follow any physical therapy that your doctor has prescribed. This may include stretching and strengthening exercises, deep massage, heat, or ultrasound.
If your Achilles tendon shortens and stiffens while you sleep, your doctor may suggest that you wear a night brace to keep your foot in a neutral position (not pointing up or down).
If you keep having pain or stiffness in the ankle area, your doctor may prescribe a walking boot or other device for 4 to 6 weeks. This keeps your lower leg and ankle from moving. It allows the tendon to heal.
If you still have Achilles tendon pain after more than 6 months of consistent treatment and rest, you might need to consider surgery.
Achilles tendon rupture
Treatment for an Achilles tendon rupture includes:
- Surgery followed by rehabilitation (rehab). This is the most common treatment for younger adults.
- Immobilizing your leg, followed by rehab. This prevents movement of the lower leg and ankle. It allows the ends of the Achilles tendon to reattach and heal.
What to think about
Don’t smoke or use other tobacco products. Smoking slows healing, because it decreases blood supply and delays tissue repair.
If you have an Achilles tendon rupture, your decision about whether to have surgery will depend in part on your:
- Age and activity level. For example, if you are an older adult who doesn’t do activities that may cause another rupture and who doesn’t want the added risk of surgery, you may choose to use a cast or similar device.
- Medical condition. If you have another medical condition—such as diabetes or heart or lung disease—that raises the risks associated with surgery, you may choose to use a cast or similar device.
- Time since injury. Over time, the torn ends of the tendon shorten and pull away from each other. If they are too far apart, the surgery is less likely to work. If surgery is chosen, many surgeons will wait a few days for the swelling to go down, then do the surgery as soon as possible. Surgery is usually done within 4 to 6 weeks.
Most Achilles tendon injuries occur during sports. If you had an Achilles tendon problem in the past, it is especially important to try to prevent another injury. To help prevent injury, try to:
- Warm up. Before any sport or intense activity, gradually warm up your body by doing 5 to 10 minutes of walking or biking.
- Cool down and stretch. After intense activity, gradually cool down with about 5 minutes of easy jogging, walking, or biking, and 5 minutes of stretches.
- Avoid any sport or intense activity that you are not in condition to do.
- Wear shoes that cushion your heel during sports or any strenuous activity.
- Wear heel pads or other orthotics that are designed to reduce stress on the Achilles tendon.
Home treatment is often used for Achilles tendinopathy as part of physical therapy or rehabilitation (rehab) after an Achilles tendon rupture.
Follow these steps to rest, heal, and strengthen your Achilles tendon and prevent further injury:
- Rest your Achilles tendon. Avoid all activities that strain the tendon, such as stair climbing or running. Try other activities, such as swimming, while you give your tendon the days, weeks, or months it needs to heal. Your doctor will tell you what you can and cannot do.
- Reduce pain by icing your Achilles tendon and taking nonprescription pain relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) as directed. Be safe with medicines. Read and follow all instructions on the label.
- Follow your physical therapy program if one has been prescribed for you. Do gentle stretching and strengthening exercises. Focus on calf stretches.
- Don’t smoke or use other tobacco products. Smoking slows healing, because it decreases blood supply and delays tissue repair.
- Wear footwear that protects the tendon while it heals.
- Quality athletic shoes that support your arches and cushion your heels can make a big difference in your comfort and healing. If needed, talk to your physical therapist or podiatrist about heel pads or orthotics.
- A bandage that keeps your foot in a neutral position (not pointing up or down) can restrict the motion of the Achilles tendon.
- A silicone sleeve or pad can distribute pressure on the Achilles tendon.
If your Achilles tendon shortens and stiffens while you sleep, your doctor may suggest that you wear a night brace to keep your foot in a neutral position.
Achilles tendon rupture
No matter how you treat an Achilles tendon rupture, after treatment it’s important to follow your rehab program. This program helps your tendon heal and helps prevent further injury.
You can use medicine to relieve pain from Achilles tendinopathy or an Achilles tendon rupture. The medicine may be prescription or nonprescription. Be safe with medicines. Read and follow all instructions on the label.
- Acetaminophen (such as Tylenol) can relieve pain.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are also often used to treat pain. But most tendon problems don’t involve inflammation, so NSAIDs usually aren’t needed. These drugs include ibuprofen (such as Advil and Motrin) and naproxen (such as Aleve).
Corticosteroid injections, which sometimes are injected around tendons or into joints to reduce pain and inflammation, aren’t used to treat Achilles tendinopathy. They may increase the risk of a tendon rupture.
Surgery usually isn’t needed to treat Achilles tendinopathy. But in rare cases, someone might consider surgery when rubbing between the tendon and the tissue covering the tendon (tendon sheath) causes the sheath to become thick and fibrous. Surgery can be done to remove the fibrous tissue and repair any small tendon tears. This may also help prevent an Achilles tendon rupture.
Achilles tendon rupture
Surgery is often used to reattach the ends of a ruptured Achilles tendon. It may provide a better chance of preventing the tendon from rupturing again compared to using a cast or other device that will keep your lower leg and ankle from moving ( immobilization).footnote 1
Surgery works best when you have surgery soon after your injury. Recovering from surgery may take months. Most surgeons will wait a few days for swelling to go down, then do the surgery as soon as possible. Surgery is usually done within 4 to 6 weeks. You will also need a rehabilitation (rehab) program to help heal and strengthen the tendon.
Surgery for an Achilles tendon rupture can be done with a single large incision, which is called open surgery. Or it can be done with several small incisions. This is called percutaneous surgery.
What to think about
The differences in age and activity levels of people who get surgery can make it hard to know if Achilles tendon surgery is effective. The success of your surgery can depend on:
- Your surgeon’s experience.
- The type of surgery you have.
- How damaged the tendon is.
- How soon after rupture the surgery is done.
- How soon you start your rehab program after surgery.
- How well you follow your rehab program.
Talk to your surgeon about his or her surgical experience. Ask about his or her success rate with the technique that would best treat your condition.
Other treatments are often used for Achilles tendinopathy or rupture. Before using other treatments, you most likely will try rest and medicine to reduce pain and swelling.
Achilles tendon rupture
A cast or similar device can be used to prevent the lower leg and ankle from moving (immobilization). This type of treatment may take as long as 6 months to completely heal a tendon. This is usually followed by a rehabilitation (rehab) program that helps you regain strength and flexibility in the tendon and leg. The rehab program may include physical therapy.
Common physical therapy treatments include:
If other treatment doesn’t reduce your pain, your doctor may recommend using a cast or other device for 4 to 6 weeks. These devices can prevent your lower leg and ankle from moving and allow the tendon to heal. This is then followed by physical therapy and changes in your activities.
Medical researchers continue to study new ways to treat tendon injuries. Talk to your doctor if you are interested in experimental treatments. Some of the treatments being studied include:
- Nitric oxide and glyceryl trinitrate, applied topically (to the skin) over the injury.
- Ultrasonic, or shock, waves directed at the injured tendon (shock wave therapy) for pain caused by calcific tendinitis (calcium built up in the tendons). For more information, see the topic Calcium Deposits and Tendinitis (Calcific Tendinitis).
- Platelet-rich plasma (PRP). In this procedure, blood is drawn from the person and spun at high speeds to separate out the blood cells called platelets. Then the platelets are injected back into the body at the injury site.
- Khan RJK, Smith RLC (2010). Surgical interventions for treating acute Achilles tendon ruptures. Cochrane Database of Systematic Reviews (9).
Current as of:
November 16, 2020
Author: Healthwise Staff
Anne C. Poinier MD – Internal Medicine
E. Gregory Thompson MD – Internal Medicine
Adam Husney MD – Family Medicine
Kathleen Romito MD – Family Medicine
David Bardana MD, FRCSC – Orthopedic Surgery, Sports Medicine
Current as of: November 16, 2020
Medical Review:Anne C. Poinier MD – Internal Medicine & E. Gregory Thompson MD – Internal Medicine & Adam Husney MD – Family Medicine & Kathleen Romito MD – Family Medicine & David Bardana MD, FRCSC – Orthopedic Surgery, Sports Medicine
Achilles Tendon Repair Surgery | Johns Hopkins Medicine
What is Achilles tendon repair surgery?
Achilles tendon repair surgery is a type of surgery to fix a damaged Achilles tendon.
The Achilles tendon is a strong, fibrous cord in the lower leg. It connects the muscles of your calf to your heel. It’s the largest tendon in your body. It helps you walk, run, and jump.
In some cases, the Achilles tendon can tear, or rupture. This is usually due to a sudden, strong force. It can happen during tough physical activity. It can happen if you suddenly move faster or pivot on your foot. Having a foot that turns outward too much can increase your risk of a torn tendon. A ruptured Achilles tendon can cause pain and swelling near your heel. You may not be able to bend your foot downward.
The Achilles tendon can also degenerate. This is also known as tendinitis or tendinopathy. This might cause symptoms like pain and stiffness along your Achilles tendon and on the back of your heel. This is most often through overuse and repeated stress to the tendon. It can result from repeated stress on your tendon, especially if you have recently been more active. Having short calf muscles can increase your risk of tendinopathy.
During the surgery, an incision is made in the back of the calf. If the tendon is ruptured, the surgeon will stitch the tendon back together. If the tendon is degenerated, the surgeon may remove the damaged part of the tendon and repair the rest of the tendon with stitches. If there is severe damage to a lot of the tendon, the surgeon might replace part or all of your Achilles tendon. This is done with a tendon taken from another place in your foot.
In some cases, the Achilles tendon repair surgery can be done as a minimally invasive procedure. This is done with several small incisions instead of one large one. It may use a special scope with a tiny camera and a light to help do the repair.
Why might I need Achilles tendon repair surgery?
You might need Achilles tendon surgery if you tore your tendon. Surgery is advised for many cases of a ruptured Achilles tendon. But in some cases, your healthcare provider may advise other treatments first. These may include pain medicine, or a temporary cast to prevent your leg from moving. And your healthcare provider may not advise surgery if you have certain medical conditions. These include diabetes and neuropathy in your legs.
Or you may need Achilles tendon repair surgery if you have tendinopathy. But in most cases, other treatments can be used to treat tendinopathy. These include resting your foot, using ice and pain medicines, and using a brace or other device to stop your foot from moving. Physical therapy can also help. If you still have symptoms after several months, your healthcare provider might advise surgery.
Depending on the type of problem you have, Achilles tendon surgery might work for you. Talk with your healthcare provider about the risks and benefits of your choices.
What are the risks of Achilles tendon repair surgery?
Every surgery has risks. Risks of Achilles tendon repair include:
- Excess bleeding
- Nerve damage
- Blood clot
- Wound healing problems
- Calf weakness
- Complications from anesthesia
- Continued pain in your foot and ankle
Your own risks may vary according to your age, the shape of your foot and leg muscles and tendons, your general health, and the type of surgery done. Talk to your healthcare provider about any concerns you have. He or she can tell you the risks that most apply to you.
How do I prepare for Achilles tendon repair surgery?
Talk with your healthcare provider how to prepare for your surgery. Tell your healthcare provider about all the medicines you take. This includes over-the-counter medicines such as aspirin. You may need to stop taking some medicines ahead of time, such as blood thinners. If you smoke, you’ll need to stop before your surgery. Smoking can delay healing. Talk with your healthcare provider if you need help to stop smoking.
Before your surgery, you may need imaging tests. These may include ultrasound, X-rays, or magnetic resonance imaging (MRI).
Do not eat or drink after midnight the night before your surgery. Tell your healthcare provider about any recent changes in your health, such as a fever.
You may need to plan some changes at home to help you recover. This is because you won’t be able to walk on your foot normally for a while. Plan to have someone drive you home from the hospital.
What happens during Achilles tendon repair surgery?
Achilles tendon surgery can be done with several methods. The surgery is done by an orthopedic surgeon and a team of specialized healthcare providers. Ask your healthcare provider about the details of your surgery. The surgery may take a couple of hours. During your surgery:
- You may have spinal anesthesia. This is so you won’t feel anything from your waist down. You’ll also likely be given sedation. This will help you sleep through the surgery.
- A healthcare provider will watch your vital signs, like your heart rate and blood pressure, during the surgery.
- The surgeon will make an incision through the skin and muscle of your calf. If you have minimally invasive surgery, the surgeon will make a smaller incision. He or she may then use a tiny camera with a light to help do the surgery.
- Your surgeon will make an incision through the sheath that surrounds the tendon. He or she will remove parts of your damaged tendon, or repair the rip in the tendon.
- Your surgeon may remove another tendon from your foot. This is then used to replace part or all of the Achilles tendon.
- Your surgeon will make any other repairs that are needed.
- The healthcare provider will close the layers of skin and muscle around your calf with sutures.
What happens after Achilles tendon repair surgery?
A healthcare provider will watch you for a few hours after your surgery. When you wake up, you will likely have your ankle in a splint. This is to keep it from moving. Achilles tendon surgery is often an outpatient procedure. This means you can go home the same day.
You will have some pain after your surgery, especially in the first few days. Pain medicines will help relieve your pain. Keep your leg elevated as often as possible. This can help reduce swelling and pain. Make sure to tell your healthcare provider right away if you have a high fever or pain in your ankle or calf that gets worse. After your surgery, you will likely need to use crutches. This is so you can keep your weight off your leg.
About 10 days after your surgery, you’ll need to return to your healthcare provider to have your stitches removed. Your healthcare provider might replace your splint with a cast at this time. If so, follow all instructions about keeping your cast dry. Or, your healthcare provider may give you a special removable boot instead of a cast.
Your healthcare provider will give you instructions about when you can put weight on your leg. He or she will tell you how to strengthen your ankle and leg muscles as you recover. You may need to do physical therapy to help with your recovery.
Make sure to follow all your healthcare provider’s instructions about medicines, wound care, and exercises. This will help make sure the surgery is a success for you.
Before you agree to the test or the procedure make sure you know:
- The name of the test or procedure
- The reason you are having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- What the possible side effects or complications are
- When and where you are to have the test or procedure
- Who will do the test or procedure and what that person’s qualifications are
- What would happen if you did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or problems
- How much will you have to pay for the test or procedure
Achilles Tendon Tear Symptoms, Causes & Treatment
An Achilles tendon tear occurs when the tendon attaching the calf muscle to the heel is completely torn. This is a common injury, most often seen in middle-aged male weekend warriors.
Jeannot Olivet / Getty Images
Three Things About the Achilles
- The Achilles tendon is the largest tendon in the body. Despite being the largest tendon in the body, the Achilles is still prone to injury. Large forces are exerted on the Achilles, particularly with sudden, explosive movements seen in sports that involve running and jumping.
- Men are about 7 times more likely to tear their Achilles. Men are much more likely to sustain an Achilles tendon rupture. Most often this injury is seen in a 20- to 40-year-old athlete, and often occurs without any contact or collision.
- Certain antibiotics and cortisone shots may make you more likely to tear your Achilles. A specific type of antibiotic, called fluoroquinolones (such as Cipro or Levaquin), have been shown to increase the likelihood of Achilles tendon problems. Cortisone shots are also associated with Achilles tears, a reason many doctors don’t recommend cortisone for Achilles tendonitis.
Symptoms of a Torn Achilles Tendon
An Achilles tendon tear, or rupture, is a traumatic injury that causes sudden pain behind the ankle. Patients may hear a ‘pop’ or a ‘snap,’ and will almost always say they feel as though they have been kicked in the heel (even though no one has kicked them). Patients have difficulty pointing their toes downward, and may have swelling and bruising around the tendon.
Your doctor will examine the ankle for continuity of the tendon. A defect in the Achilles tendon can often be felt after a tear. In addition, squeezing the calf muscle should cause the foot to point downwards, but in patients with a torn Achilles tendon, the foot will not move (this will cause positive results on the Thompson test). X-rays may be performed to evaluate for other conditions including an ankle fracture or ankle arthritis.
Risks That May Causes a Torn Achilles Tendon
Achilles tendon ruptures are most commonly seen in men who are around the age of 30 or 40. About 15 to 20% of patients have symptoms of Achilles tendonitis prior to sustaining an Achilles tendon tear, but the vast majority of patients have no history of prior Achilles tendon problems. Over 75% of Achilles tendon tears are associated with playing ball sports (commonly basketball or tennis).
Other risk factors that are associated with Achilles tendon rupture include:
Fluoroquinolone antibiotics are used very commonly in medicine for treatment of respiratory infections, urinary tract infections, and other bacterial infections. These antibiotics, such as Cipro, Levaquin, and others, are associated with Achilles tendon rupture. Exactly why this is the case is unclear, but patients on these medications should consider an alternative medication if Achilles tendon pain develops.
Treatment of an Achilles Tendon Tear
Treatment of an Achilles tendon tear can consist of either surgery or non-surgical techniques. The benefit of surgery is there is often less immobilization. Athletes can often get back to sports faster, and there is probably a smaller chance of re-rupture of the Achilles tendon. The advantage of non-surgical treatment is that the potential surgical risks are avoided, and the long-term functional results are similar to those patients that undergo surgical treatment.
Achilles tendon injuries: Why do they take so long to heal? | Orthopaedics and Rehab
The Achilles tendons, which get their name from the mythological Greek hero whose lone weakness was in his heel, are the largest and strongest tendons in the body. On average, they are approximately 6 inches long and 5 millimeters thick. The Achilles is extremely important in walking, running, and jumping. Connecting the heel bones to the calf muscles at the back of the ankle, the Achilles tendons are strong enough to withstand the force of up to 1,100 pounds.
Achilles tendons are made up of strong fibrous tissue, but this tissue does not have the greatest blood supply and that is why they are predisposed to injury and rupture.
But overstretching or straining can result in a torn tendon. Achilles tendon tears are typically classified as follows:
- Partial tear, in which some of the tendon fibers remain connected
- Compete tear, in which the tendon ruptures and all the fibers disconnect from each other
Why does recovery take so long?
Unlike muscle tissue, tendons don’t get a significant supply of blood. Blood delivers fluid and nutrients that are essential for healing.
The less blood delivered, the longer it takes for tissue to heal. Add to that the sheer size of the Achilles tendon, and you’re in for a lengthy recovery. Even for professional athletes these are usually season-ending injuries, and in some cases career-ending injuries.
With a tear or rupture, you’ll likely be out of commission for at least one season of your sport of choice. Even walking will be difficult, if it’s possible at all, for several weeks during initial recovery.
Your treatment plan will depend on many factors, including the severity of the injury. The non-surgical approach involves keeping the foot and ankle flexed downward with a boot or cast, followed by physical therapy. The goal would be for the tear to heal itself. However, many cases require surgery for proper healing.
What happens in Achilles tendon repair surgery?
Surgical repair is usually an outpatient procedure followed by several weeks of protection in a cast or boot. Physical therapy and exercises may begin as soon as the surgical incision is healed.
You will be placed under anesthesia to sleep through the surgery. The surgeon will open the skin of the calf and back of the ankle. In some cases, minimally invasive or percutaneous repair through small incisions can be used. In other cases, an incision of about three to four inches may be necessary.
During the procedure, the surgeon will open the sheath of tissue around the tendon and remove damaged tissue. Then, they will repair the tear. If the tear is significant, the surgeon might remove a small piece of tendon from elsewhere in your foot and use it to replace a portion of the Achilles tendon. Then, the surgeon will close the incision with sutures. Most patients can return home the same day.
With surgical or nonsurgical treatment, you likely will be walking normally in about three months. Physical therapy will focus on regaining strength in the leg and tendon, as well as increasing flexibility so you can safely perform more explosive athletic maneuvers such as running, jumping, or pivoting.
Damage to the Achilles tendon – ProMedicine Ufa
Achilles tendon injury is one of the most common closed soft tissue injuries of the lower leg. It is a complete or partial rupture of the junction of the heads of the triceps muscle of the leg and its transition to the calcaneus. It is more often observed in persons aged 30 to 50 years, often leading an active lifestyle or in the past involved in sports.
Unlike most other tendon injuries, damage to the Achilles tendon is almost always complete.
Symptoms of rupture of the Achilles tendon include: sharp pain, swelling, limitation of movement in the foot, palpation of the “failure” in the Achilles tendon. Diagnostics is carried out mainly according to the results of examination by a traumatologist. Additionally, MRI or ultrasound can be performed. Treatment – surgical or percutaneous suturing of the tendon with immobilization of the foot for 1 month.
There are two types of injuries in which rupture is possible: direct and indirect injury.
Direct trauma. It means a directed blow to a stretched muscle, for example, when playing sports, in particular football. Potential injury with a sharp object or deliberate injury. In this case, the rupture belongs to the category of open injuries, all the rest are closed cases (subcutaneous).
Indirect injury. In case of an unsuccessful fall from a height on the toe of the foot or a jump.
In addition, the causes of the destruction or weakening of the tendon may lie in a hereditary predisposition.
The external manifestations of tendon rupture, and it is usually sharp and complete, are practically similar in all patients. They are characterized by sharp pain, as if someone behind had struck a muscle with a blunt object or slashed with a razor. In this case, the mobility of the leg completely disappears, the triceps muscle can no longer pull up the foot due to the torn tendon. Cyanotic edema appears, starting from the site of injury, and ending with the tips of the fingers. It is almost impossible to step on the foot, lameness appears, the mobility of the foot itself is paralyzed.
In some cases, you can feel a depression on the gastrocnemius muscle, indicating a complete rupture of the tendon. In a successful case, the resulting injury can be only a sprain, the treatment of which is much faster and easier.
Radiography for rupture of the Achilles tendon gives practically no results. The fact is that the tendon tissue does not block X-rays. However, in some cases, x-rays can indirectly indicate injury to this tendon, for example, when a fracture of the shin bone is detected.
Ultrasound and / or magnetic resonance imaging is used to diagnose Achilles tendon rupture. An MRI will also help diagnose Achilles tendon sprains.
Conservative method. The essence of this method is to immobilize (immobilize) the lower leg using a plaster splint with an extended toe of the foot for 6-8 weeks. The elongated toe allows the torn ends of the tendon to be brought closer to each other, ensuring their gradual fusion.
Conservative treatment is possible only in the first hours after the onset of the injury. In the future, it will be simply impossible to match the ends of the tendon.
Surgical treatment for rupture of the Achilles tendon is much more effective than conservative.
In case of an open injury, the tendon is sutured end-to-end (if there is no defect and no fiber separation). The ends of the tendon are connected and stitched with interrupted and U-shaped lavsan sutures or chrome-plated catgut. Sometimes a wire is used and removed after 6 weeks.
In the presence of a tendon defect, the first step is plastic correction.
In case of closed injuries, the skin is first dissected, then both ends of the tendon are brought to each other, after which suturing is performed. Plastic restoration is possible. For this, flaps of the proximal and distal end of the tendon are used.
After the surgical treatment, the leg is immobilized with a plaster or polymer bandage, which after 3 weeks is changed to a “boot”.The foot is placed in a slightly bent position (5-10 degrees). The heel is attached to the plaster cast, which allows you to fully load the leg. After another 3 weeks, the bandage is removed altogether.
After the termination of immobilization, the lower leg is fixed with an elastic bandage, therapeutic exercises, massage, swimming, etc. are prescribed. Within a month after removing the cast, you must wear shoes with a heel of at least 2.5 cm.
Achilles tendon rupture
Achilles tendon rupture is a rupture of tendon fibers causing pain and loss of function.Tendon rupture is treated promptly.
Achilles tendon rupture is common in beginner athletes trying to play / train too hard, and less common in well-trained professional athletes. Trauma is more common in men than women, and the frequency of rupture increases with age 30.
Signs and Symptoms
A clicking sound may be heard when the Achilles tendon ruptures. The person may feel like they have been hit on the back of the lower leg.This is accompanied by the sudden onset of acute pain in the tendon and loss of strength and function. If a complete rupture occurs, it may not be possible to lift the heel off the ground or act with your toes. Often, the degree of pain experienced, or lack thereof, can be inversely proportional to the degree of injury, meaning that a partial tear may be more painful than a complete tear.
The Achilles tendon is a powerful bundle of fibrous connective tissue that attaches the calf muscle to the heel bone.When the muscle contracts, the tendon pulls on the heel, causing the leg to move.
Achilles tendon rupture occurs if the load applied to it is greater than the tendon’s ability to withstand this load. This usually occurs as a result of sudden, rapid movement, when a strong stretching of a tendon or muscle contraction occurs, such as jumping, sprinting, or pushing off. This happens most often in sports that require a lot of abrupt starts and stops (acceleration-deceleration), such as tennis, basketball.
Achilles tendon averaged 15 cm in length. Most tears occur 3-6 cm higher where the tendon attaches to the heel bone. This is the narrowest part of the Achilles tendon.
Achilles tendon rupture is most common when muscles and tendons have not been properly stretched and warmed up prior to training, or when the muscles are tired. The Achilles tendon has poor blood supply, making it susceptible to injury and slow to heal after injury. During exercise, the amount of blood that can enter the tendon decreases, further increasing the risk of rupture.
Most experts agree that there are no warning signs of an impending rift. However, frequent episodes of the Achilles tendon (tendon inflammation) can weaken the tendon and make it more prone to rupture.
Other factors that can increase your risk of ruptured Achilles tendon include:
- Being middle-aged and male
- Dense calf muscles and / or Achilles tendon
- Changing the running surface, e.g. from grass to concrete
- Wrong or bad shoes
- Change of shoes, for example: from heels to flat shoes.
Certain medical conditions, such as gout, tuberculosis, and systemic lupus erythematosus, are thought to increase the risk of rupture of the Achilles tendon.
If an Achilles tendon rupture is suspected, it is important to see a doctor immediately to make an accurate diagnosis and recommend appropriate treatment. Before consulting a doctor, it is important that the leg hang down and the toes point towards the ground . This prevents the ends of the torn tendon from stretching.
The doctor will review the entire medical history, including any previous injuries to the Achilles tendon and what actions were taken at the time the actual injury occurred.
The doctor will also perform a physical exam and check for swelling, tenderness, and range of motion in the lower leg and foot. A noticeable tear may be felt in the tendon at the site of the complete rupture. This is most evident immediately after the tear has occurred, and the swelling will eventually make it difficult to feel the tear.
One of the tests commonly used to confirm ruptured Achilles tendon is the Thomson test. For this test, the patient lies face down on the examination table. The doctor then contracts the calf muscles; an action that usually causes the foot to be extended like a ballerina (plantar flexion). When a partial rupture has occurred, the leg’s ability to point may be impaired. When a complete rupture has occurred, the foot may not respond at all.
Ultrasound scans and MRI (magnetic resonance imaging) of the Achilles tendon may also be recommended to determine the extent of rupture.
After confirmation of the diagnosis of Achilles tendon rupture, referral to an orthopedic specialist for treatment is recommended.
Treatment can be non-surgical (conservative) or surgical. Factors such as the location and extent of the rupture, the time elapsed since the rupture, and the specialist’s and patient’s preferences will be considered when deciding what treatment to take. In some cases of rupture that does not respond well to nonsurgical treatment, surgery may be required at a later stage.
Many studies have been conducted regarding the effectiveness of each treatment. Surgical treatment in the past was the most preferred form of treatment for ruptured Achilles tendon and was most often used in cases of complete rupture. Recent research, however, suggests that surgical treatment does not necessarily lead to a better outcome than non-surgical treatment.
Both types of treatment have advantages and disadvantages. For example, the likelihood of re-rupture may be lower with surgical treatment, while non-surgical treatment avoids the risks associated with surgery, which include wound infection, nerve damage, and risks associated with the use of a general anesthetic.Therefore, it is important to discuss the advantages and disadvantages of each treatment option with a specialist and get a clear explanation of why a particular treatment was recommended.
While immobilization is in use, it is important not to step on the foot and keep it in an elevated position while resting. This will help reduce swelling and promote healing. You need to use crutches or a cane.
After removing the immobilization, an individual rehabilitation plan begins, including physiotherapy and special exercises.The goal of rehabilitation is to restore the strength of the Achilles tendon and calf muscles and the range of motion of the ankle joint. It may be advisable to avoid flat shoes and / or raise the heel in the shoe. This helps relieve stress on the Achilles tendon.
It may take six months to a year for the Achilles tendon to return to full strength. During this time, it is very important to follow the instructions of the specialist and physical therapist to prevent further damage to the Achilles tendon.
Recent studies show that earlier and more intensive rehabilitation after surgery results in greater patient satisfaction and improved physical function without increasing the risk of re-rupture.
The following can significantly reduce the risk of Achilles tendon rupture:
- Adequate pre-workout stretching and warm-up
- If you are involved in seasonal sports, do preparatory exercises to build strength and endurance before preparing for the sports season.
- Maintain a healthy body weight. This will reduce the stress on the tendons and muscles
- Use footwear suitable for sports or activities
- Train Within Fitness and Follow a Reasonable Exercise Program
- Increase exercise intensity gradually and avoid unfamiliar exercises
- Gradual cooling down after training
- Stretching and strengthening exercises for the calf muscles that will allow the Achilles tendon to absorb greater forces and prevent injury.
90,000 pain localized in the Achilles tendon
What is achillodynia and how does it develop?
Achillodynia is a pain syndrome resulting from inflammation of the Achilles tendon and the surrounding membranes. The disease usually develops after excessive exertion. Untrained people after overly intense training often suffer from Achillodynia. This applies not only to running disciplines, but also to other sports.
People with overweight also often have problems with the Achilles tendon. Rheumatism and deformities of the foot increase the risk of developing achillodynia.
Being the most powerful tendon in the human body, the Achilles tendon (lat. tendon Achillis ) transmits the force of the leg muscles to the foot.This ensures the separation of the foot from the surface when walking and running. Running on the Achilles tendon is exerted by force eight times your own weight. 1
Anatomy of the Achilles tendon
Risk factors and causes
The main cause of Achillodynia is overstrain of the Achilles tendon.At the same time, the activities that can cause pain are very diverse.
- Intensive running and jumping loads
- Unusual loads, for example, too heavy loads after starting sports
- Systematic overload
- Unsuitable footwear
- Taking some antibiotics
- Foot deformities
- Shortening of tendons or muscles
- Increased uric acid levels
- Rheumatic diseases
Signs and symptoms
The clinical picture ranges from discomfort to inflammation of the Achilles tendon.In some cases, inflammation can cause a real rupture. Typical symptoms of inflammation: pain, localized fever, edema and dysfunction .
At first, symptoms appear only at the beginning of physical activity and disappear after a short period of activity. In the future, pain and swelling persist for a long time.
Treatment of achillodynia
Treatment of achillodynia is almost always conservative .The earlier the treatment starts, the more successful it is. The most effective complex treatment, which consists of the items listed below.
- Physiotherapy exercises: Special eccentric exercises 2 promote the rebuilding of the tendon tissue. It is recommended that you exercise for a few minutes twice a day. Depending on the clinical picture and phase of the disease, the doctor may prescribe physiotherapy (ultrasound), electrotherapy (TENS), cross kneading (special massage), shock wave therapy or acupuncture.
- Bandages: Special medical devices (eg Achimed by medi) reduce stress and strain on the Achilles tendon. The compression band and the built-in silicone insert work together to gently massage the Achilles tendon and improve blood circulation in the inflammation area, which reduces pain. Additionally, in the acute phase, patients can relieve pain in the Achilles tendon with heel pads that are used simultaneously in both shoes.
- Insoles: Orthopedic insoles (eg igli Heel Spur Light) reduce stress on the Achilles tendon.
- Cold : cooling compresses relieve pain and swelling (temperature of the compress is about 7 ° C).
- Heat : A heating pad, hot water bottle or massage with a towel soaked in warm water improves blood circulation in the area of inflammation.
- Medication : Patients take anti-inflammatory drugs such as ibuprofen or diclofenac for one to two weeks as needed and as recommended by their healthcare provider.
- Ointments : Anti-inflammatory creams or ointments can be rubbed into the affected area several times a day.
The treatment plan is drawn up by the attending physician individually for each patient. This takes into account the special needs of the patient and the clinical picture at the current time.
Eccentric exercise 2 is an effective treatment for achillodynia.This has been proven by various studies 3 . Among such exercises, , the shin lift is considered the main one.
Exercise should be done twice a day for a minimum of 12 weeks.
The exercise can be performed on a step (eg a ladder) and does not require fitness equipment.
Important to know:
During the first two weeks of doing the exercises, pain in the muscles of the lower leg is possible.Be patient and continue to do the exercise conscientiously. If the pain gets too much, reduce the number of sets. If this does not help relieve pain, and if you experience pain during daily activities, stop exercising and see your doctor.
A set of exercises for achillodynia
In addition to the main exercise, you can do other exercises to strengthen the Achilles tendon.Medi has partnered with Dr. Mathias Marquardt, a sports physician and active athlete, to create a set of exercises for the home. In the videos, Dr. Matthias Marquardt teaches professional triathlete and physical therapist Laura Philippe how the exercises are done correctly. The optimal frequency is three to four times a week .
Consult your doctor before exercising to see if it is right for you.
Coordination – standing on one leg
Stabilization pad (alternative: rolled towel, folded training mat).
- Standing barefoot on exactly one leg on a pillow
- Keep the knee of the leg on which you are leaning slightly bent
- Raise the other leg up (stand on one leg) (Fig. 1)
- The soft surface of the pillow creates instability that must be compensated for.
- Exercise activates the muscles of the foot and thigh.
- Make sure your torso is tense and you are standing up straight.
- To do this, tense your abdominal muscles and straighten and straighten your shoulders.
- You can simplify the exercise by performing it on a hard surface (without a pillow)
- You can complicate the exercise by drawing the number 8 with your free leg (Fig. 2)
- To complicate the exercise, you can raise the knee of your free leg (fig.3)
- You can complicate the exercise by raising the knee of the free leg (Fig. 3)
- Three sets for each leg, each hold for 30 seconds
- Take a 15-second break after each set
Straight Knee Calf Raise
- Optional: side rail
- Stand on the edge of the step with the front of the foot
- Heels should not be on the step
- Stand on tiptoe without bending your knees
- a healthy leg in the knee (Fig.1)
- Slowly lower yourself on the supporting leg so that the heel is below the level of the step (Fig. 2)
- Raise so that the heel is at the level of the step
– keep your back and head straight
– make sure that the knee joint does not deviate inward or outward
- You can complicate the exercise by doing a tiptoe lift with bent knees
- You can complicate the exercise by doing it with weights (for example, with a backpack)
- 3 sets of 15 repetitions with each leg
- Take 30 second breaks between sets
Bent knee shin lift
- Optional: side rail
- Stand on the edge of the step with the front of your feet
- Heels should not rest on the step
- Stand on tiptoe with slightly bent knees (approximately 60 °)
- Bend your good leg at the knee (Fig.1)
- Slowly lower yourself on the supporting leg so that the heel is below the level of the step (Fig. 2)
- Raise so that the heel is at the level of the step
– keep your back and head straight
– make sure that the knee joint does not deviate inward or outward
- You can make the exercise easier by doing a tiptoe lift with straight knees
- You can complicate the exercise by doing it with weights (for example, with a backpack)
- 3 sets of 15 repetitions
- Take 15 second breaks between sets
Stretching – roll of the lower leg on the roller
- Optional: Training mat
- Sitting on the floor
- Bend one leg and place the calf of the other leg on the roller
- Place your hands on the floor (fig.1)
- Raise the pelvis.
- Now slowly roll the roller back and forth along the entire length of your calf, from the Achilles tendon to the hamstring.
- You will feel the pressure point moving across the calf muscle.
- The muscles of the trunk are involved in movement (Fig. 2).
- Bend your toes to release the posterior calf muscle group.
- The exercise may be a little painful at first, but the pain should not be unbearable.
- Complicate the exercise by rolling both legs at the same time
- Complicate the exercise by crossing your legs
- 3 sets of 10 repetitions (forward and backward) with each leg
- Rest 30 seconds between sets
Achimed brace will help reduce pain in the Achilles tendon without limiting the range of motion in the ankle joint.
Silicone inserts in the projection of the Achilles tendon have a massaging effect and protect the tendon from external mechanical stimuli.
Learn more about the Achimed brace.
1 Klein, C.: Orthopädie für Patienten [ Orthopedics for Patients ]. Publisher: Michels-Klein, Remagen 2014
2 Eccentric training means loading a muscle or a tendon by slowing down a weight or resistance.
Ligament damage often occurs during sports.
Tendons and ligaments
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Sports and recreation
Achilles tendon rupture
Achilles tendon – the most powerful tendon in the human body
The Achilles tendon transmits force from the triceps muscle of the lower leg to the foot and plays a very important role in the rolling of the foot.When you run, a force equal to eight times your body weight acts on the Achilles tendon. This fact indicates that the Achilles tendon is under tremendous stress. A healthy tendon is able to withstand such loads and perform its stabilizing function. However, constant overload, especially against the background of a genetically determined weakness of the connective tissue, can lead to disease.
Causes of rupture of the Achilles tendon
Sports injuries are the most common cause of ruptured Achilles tendon.
Symptoms of ruptured Achilles tendon
Characteristic symptoms of rupture of the Achilles tendon
- The patient feels that something has “burst” or there has been a “sharp blow” to the leg.
- After a rupture, dorsiflexion of the foot is impossible.
- Walking on toes is not possible, but there is no sharp pain.
- On palpation, an interval or thinning along the tendon is determined.
- Achilles tendon reflex is not triggered.
Operate or not?
It is believed that the best effect of the operation is achieved when it is performed in the first hours after the injury. After surgery, the foot is immobilized for several weeks in a dorsiflexion position. After about four to six weeks, the patient begins to perform physiotherapy exercises with a gradual return to the physiological position of the foot. A low heel should be used to temporarily relieve tension on the Achilles tendon.
Achilles tendon rupture can be treated conservatively. The disadvantage of this method is the shortening of the tendon, which changes the biomechanics of the foot and gait. Therefore, doctors usually recommend surgical treatment.
After surgery, the ankle is immobilized for four to six weeks.Then they begin to perform therapeutic exercises in order to gradually restore the length of the tendon. In many cases, heel pads are used to relieve pain in the Achilles tendon.
medi products for ankle joint
An alternative is the so-called postoperative functional treatment with special shoes.
The medi support medi ROM Walker from medi helps to quickly get the patient back on his feet. The boot provides circular compression. Its special rockade outsole even provides a physiological gait. medi ROM Walker can be used in cases of severe edema and the need for quick access to the postoperative wound.
In addition, the orthosis can be used as an adjunct to conservative treatment.
Find out more about medi ankle braces and braces.
Klein, Dr. med. Christoph (2014): Orthopädie für Patienten. Medizin verstehen. Remagen: Verlag Michels-Klein
Ligament damage often occurs during sports.
Tendons and ligaments
Find out which sport suits you best
Sports and recreation
90,000 How to treat an Achilles tendon rupture.Surgical and conservative treatment
Achilles tendon ruptures are most common in athletes and active people between the ages of 30 and 55. This age group is at risk because these patients are still quite active, but over time, their tendons tend to become more rigid and gradually weaken.
As a rule, this occurs when performing actions that require a sharp acceleration or change in direction of movement (for example, basketball, tennis, etc.).). Patients usually describe sharp pain in the heel area as if they were “stabbed with a stick in the Achilles tendon area.” Acute rupture of the Achilles tendon is diagnosed when examining the patient; radiography in this case is not very effective.
The Achilles tendon is the largest and strongest tendon in the body (Fig. 1). It can withstand a load 2-3 times the body weight during normal walking, so restoring the normal functioning of the Achilles tendon is extremely important.
Achilles tendon rupture can be successfully treated without surgery or surgically. In both cases, it should be treatment in compliance with all the rules and regulations. Recent studies show that non-surgical and surgical treatments for ruptures of the Achilles tendon lead to the same results.
Surgical treatment results in slightly faster recovery and a lower re-rupture rate. However, surgery can be associated with very serious complications, such as infection or problems with the healing of postoperative wounds.
Therefore, conservative treatment may be preferable for people suffering from diabetes mellitus and vascular diseases, as well as heavy smokers.
Figure 1: Achilles tendon
Mechanism of trauma and clinical presentation
Tears usually occur when an athlete puts stress on the Achilles tendon in preparation for take off. This can happen when the direction of movement changes abruptly, when starting a run or preparing to jump (Fig. 2).
Tears are caused by the muscles in the calf exerting tremendous force through the Achilles tendon as the body moves.At the moment of injury, patients feel acute pain in the back of the lower leg or foot, many describe this sensation as if they were hit from behind with a stick, a click is often heard.
After trauma, an area of retraction or deformation appears along the Achilles tendon, edema, hematoma. Patients walk, limping on an injured limb, cannot stand on the toes. Partial rupture of the Achilles tendon is not common.
Painful tendonitis (inflammation) of the Achilles tendon or partial rupture of the calf muscles (calf) as they attach to the Achilles tendon can also cause pain in this area.The pain of a ruptured Achilles tendon can quickly subside, and the injury may be considered a sprain on initial examination in the emergency department.
Fig. 2. The mechanism of injury – a sharp change in the direction of movement to the maximum load of the Achilles tendon
Figure 3: Maximum Walk Load – Heel Raise
A ruptured Achilles tendon can be easily diagnosed during a specialist examination.The most frequent localization of ruptures is 2.0-5.0 cm above the place of attachment of the tendon to the heel bone. The main way to determine the presence or absence of an Achilles tendon rupture is to perform the Thompson Test .
The patient lies on his stomach so that the feet hang freely from the edge of the couch, after which the doctor squeezes the gastrocnemius muscles. If the integrity of the tendon is not compromised, the foot will elevate [plantar flexion]. If there is a ruptured tendon, there will be no movement.
Patients often mistakenly believe that their tendon is working properly if they can move their foot up and down.However, this is only possible in a sitting position because the adjacent muscles and tendons are intact.
When you try to lift your leg up in a standing position and transfer body weight to the injured limb, pain and weakness will appear. If an Achilles tendon rupture occurs, it will be incredibly difficult for the patient to stand on the toes for any length of time – this is called the STAMP test . The sensitivity and circulation of the foot and ankle are generally not affected.
In an acute tendon rupture, a clinical examination is usually sufficient to make a diagnosis. Radiography can be useful only if there is a suspicion of an avulsion fracture of the calcaneus (a situation in which the Achilles tendon separates from the calcaneus with its fragment).
The gap can be seen on ultrasound or MRI. However, these studies are not needed for acute ruptures, unless there is some uncertainty about the diagnosis.These examinations are very useful for chronic ruptures or chronic Achilles tendon diseases.
Achilles tendon rupture can be treated without surgery or promptly. Both treatments have their own advantages and disadvantages. Recent studies have shown that non-surgical and surgical treatment of Achilles tendon ruptures provide equivalent results.
The choice of treatment method depends on the specific case and patient. It is important to understand that Achilles tendon ruptures must be treated. A neglected (ignored) rupture of the Achilles tendon leads to negative consequences such as chronic pain syndrome, lameness, dysfunction of the injured limb. In addition, old breaks are much more difficult to treat, and the results of treatment are worse, moreover, the rehabilitation period is increased.
The doctor only helps nature to restore the integrity of the Achilles tendon, his task is to create comfortable conditions for the regeneration process, namely to bring the torn ends of the tendon closer together and, for the time necessary for recovery, to immobilize them.With the conservative method of treatment, the doctor achieves the convergence of the ends of the tendon with the position of the foot, with the operative method, he sews the ends of the tendon with threads.
With this method of treatment, the foot is removed and fixed in the equinus position (the foot in the position of maximum plantar flexion). In this position of the foot, the maximum convergence of the free ends of the Achilles tendon occurs. For this, a plaster (polymer) bandage or a rigid hinge cut for the ankle joint with the ability to adjust the angle and heel pad can be used.
With conservative treatment, rehabilitation can be more aggressive – patients are allowed to partially load the injured limb from the first day, but full load is allowed only after 6 weeks from the moment of injury. Modern rehabilitation protocols are aimed at activating patients as early as possible while protecting the injured tendon from significant stress that can lead the healing tendon to rupture or sprain.
It is extremely important that this approach preserves the function of the lower leg muscles.It is necessary to monitor the condition of the tendon throughout the entire period of non-surgical treatment. This can be done by clinical examination and / or ultrasound. If there are signs of diverging tendon ends or lack of adhesion, surgical treatment should be considered.
The main advantage of non-surgical treatment is the absence of incisions and punctures in this area, therefore, there can be no problems with wound healing or infection.Wound infection after Achilles tendon surgery can lead to serious complications, therefore non-surgical treatment should be considered for many patients, especially those with diabetes mellitus, vascular disease, and patients who smoke for a long period of time.
The main disadvantage of non-surgical treatment is that recovery may be slightly slower. Full recovery occurs 2-4 weeks later than with surgery.In addition, with conservative treatment, the risk of re-rupture of the tendon increases. Repeated tears usually occur 8-18 months after the primary injury.
Surgical treatment for ruptured Achilles tendon begins with opening the skin and identifying the torn tendon. Its severed ends are then stitched together to create a stable structure. This can be done with the standard Achilles tendon repair method or with a minimally invasive method (with mini incisions and skin punctures).
Open restoration of the Achilles tendon
Reconstruction of the Achilles tendon is most often performed through a skin incision made in the projection of the tendon rupture along the posterior surface of the lower leg. The site of the rupture of the Achilles tendon is reached, then the loose ends are trimmed economically, cleaned and prepared for stitching. The foot is brought to the position of maximum plantar flexion, so that the tendon tension is minimal, and the torn ends of the tendon are as close as possible, after which suturing occurs.After stitching the ends of the tendon, the wound is thoroughly washed, bleeding is controlled, sutures, aseptic dressing, elastic compression and immobilization using a plaster cast or a rigid cut are applied to the skin. Cold locally. (see fig. 1).
A possible disadvantage of open repair of a ruptured Achilles tendon is the problem of wound healing, which can lead to a deep infection that is difficult to repair, or a painful postoperative scar.
Figure 1: Open repair of ruptured Achilles tendon
Minimally invasive method of restoration of the Achilles tendon
Another method of repairing the Achilles tendon is through a “mini” skin incision.In this case, in the projection of the tendon rupture, a small horizontal incision is made 1.5-2.0 cm long. The free ends of the tendon are mobilized and taken out into the wound, the loose ends are cut economically, cleaned and prepared for stitching.
Through punctures in the skin, the ends of the tendon are sutured at a distance of 2.0 – 4.0 cm from the rupture site, the foot is brought to the position of maximum plantar flexion so that the tendon tension is minimal, and the torn ends of the tendon are as close as possible, then suture occurs.
After suturing the ends of the tendon, the wound is thoroughly washed, bleeding is controlled, sutures are applied to the skin, aseptic bandage, elastic compression and immobilization using a plaster cast or a rigid cut. Cold locally.
Benefits of this technique include less soft tissue damage, less scar formation and better cosmetic benefits. Disadvantages include a higher risk of damage to the sural nerve, since, unlike open surgery, sutures are applied without exposing the entire length of the tendon, making it difficult to see if the nerve is in the surgical site.
A nerve that could potentially be damaged will numb the outside of the dorsum of the foot, near the little toe. It is possible that the tendon suture itself may not be as strong as with the open technique, which can lead to a faster re-rupture. (see fig. 2)
Figure 2: minimally invasive method of repairing the Achilles tendon
Benefits of surgical treatment for the Achilles tendon include the following:
- faster recovery
- Possibility of early range of motion in the leg muscles, therefore the rehabilitation program can be more aggressive
- lower re-rupture percentage (re-rupture rate is significantly lower in patients after surgery (2-5%) than in those who have undergone conservative treatment (8-12%)
Possible complications of surgical and conservative treatment
- asymmetric gait (leading to pain in other areas)
- deep vein thrombosis of the lower extremities
- pulmonary embolism
- Achilles tendon nonunion
- Repetitive Breaks
Complications after surgical treatment
Non-healing of wounds
Although this is usually a common complication for most operations, complications in wound healing are especially dangerous when repairing the Achilles tendon.Because in the area of the Achilles tendon there is little surrounding soft tissue, and this area of the skin has a deliberately poor blood supply. Hence, any kind of wound healing problem can easily affect the tendon itself. For most patients, there is an approximately 2-5% risk of developing a wound healing problem. However, this risk increases significantly in smokers and patients with diabetes mellitus.
Deep infection after repair of the Achilles tendon can be a huge problem.Infection often occurs when there is a problem with wound healing that allows bacteria from the outside world to infect the repaired Achilles tendon. Treatment may require not only antibiotics, but the eventual removal of all sutures and, in some cases, removal of the tendon. Smokers and diabetics are at increased risk of serious wound infection after Achilles tendon repair surgery.
Nerve damage / neuritis
Numbness of the skin in the area of the postoperative scar is a rather frequent complication.A more serious problem is damage to the nerve, which is responsible for muscle function or sensory control. This can happen when a nerve is entangled in a suture or damaged by an instrument during surgery. Damage to one of the nerves in the foot often results in neuritis (painful inflammation of a nerve). The initial damage to the nerve can be relatively minor, for example: a nerve that stretches when soft tissue is pulled in during surgery; or a nerve that becomes entangled in scar tissue that forms in response to postoperative bleeding.This type of nerve irritation creates symptoms such as numbness and / or a burning sensation along the nerve. Localized nerve damage is often associated with a surgical incision, and pressing on the area of the nerve injury can cause severe pain or discomfort along the nerve.
Rehabilitation after ruptured Achilles tendon
During the first 6-8 weeks, the leg is immobilized in a cast or orthosis so that the tendons and surrounding tissues heal properly.In addition, the tendon must be protected because the healing Achilles tendon may still be too weak to withstand the stress of normal walking. After 6-8 weeks, the patient’s foot is placed in a removable boot, often with a slight heel lift, in order to relieve the Achilles tendon slightly.
From this point on, the patient can begin to walk, but at a slow pace. Physiotherapy and physiotherapy exercises aimed at developing movements and strengthening the tone of the muscles of the lower leg, as a rule, begins 6-8 weeks after the operation.The heel lift is gradually retracted over several weeks, bringing the foot back to a neutral position. In the case of a standard recovery, the patient can wear normal shoes again 9-14 weeks after surgery.
More aggressive sports rehabilitation after rupture of the Achilles tendon is indicated for young patients and professional athletes, provided that they are disciplined.
Below is a sample step-by-step rehabilitation plan to help you recover faster and more effectively from a ruptured Achilles tendon.
Ideally, rehabilitation is most effective in specialized centers under the guidance of professional rehabilitation therapists.
The lower leg is fixed at an angle of 20 degrees of plantar flexion (or a heel pad 2 cm of the rise is placed under the heel in the orthosis). Axial load on the leg is prohibited. Walking within the apartment with crutches. In the event of an operation, dressings are performed during this period. Prevention of thrombosis.
The lower leg is still in plantar flexion.Exercise begins, several times a day without a splint. The exercises consist of gentle rocking movements (up and down) of the ankle joint, trying to keep the Achilles tendon in a neutral position (90 degrees). In addition, inversion and eversion of the foot, as well as the lower leg, are performed with slight plantar flexion. Axial load on the leg is prohibited. Walking with crutches. Prevention of thrombosis.
An increase in the load on the leg is allowed. Walking with a dosed load on the operated limb.Continue to do the exercises above and wear the splint day and night. Prevention of thrombosis.
Retract the instep under the heel and continue to wear the splint. Exercise progresses with a slow 90-degree stretch of the tendon. Resistance exercises are added to strengthen the calf muscles. Prevention of thrombosis.
Little by little they get out of the habit of the splint, use crutches as needed. Movement volume, stability and proprioception are gradually optimized.Balancing cushion exercises are added.
It is important to understand that in order to return to previous activity, it is necessary to wait for the full healing of the Achilles tendon.
Prevention of damage to the Achilles tendon
Following these simple steps will help you to significantly reduce the risk of damage to the Achilles tendon
- Warm up before starting workout
- Use pre-workout sports warming ointment
- train in specialized shoes
- Use custom made orthopedic insoles
- Match the level of physical activity with your age and fitness level
- after workout, be sure to stretch
- use cold after stretching
- If you experience discomfort during and after physical activity, consult a doctor
First aid for ruptured Achilles tendon
If you have a ruptured Achilles tendon or it seems to you that something is wrong, you need to follow these steps
- Stop training
- Apply cold to the Achilles tendon area
- Take painkillers
- Give the injured limb an elevated position (foot above the heart)
- try not to step on the injured limb
- call an ambulance or get to the hospital on your own
Achilles tendon injury!
1.Achilles tendon injuries and causes
Achilles tendon injuries are most common in professional and recreational athletes. The Achilles tendon is one of the longest tendons in the body. It starts in the area of the bones of your heel and stretches to your calf muscles. You can feel this elastic band of tissue at the back of your ankle and above your heel. The Achilles tendon allows the foot to extend and guide the toes down toward the floor.One of the common problems with tendons is tendonitis, an inflammation of the tendon tissue that causes it to swell and cause pain. Too much stress on the tendon can lead to its partial or complete rupture, and this is already a serious injury.
Causes of rupture and stretching of the Achilles tendon
Achilles tendon injury can be caused by:
- Excessive loads.
- A sharp increase in physical activity.
- Insufficient warm-up and preparation of the tendons for stress before training.
- Wearing high heels, which increases the stress on the tendons.
- Problems with the legs. Achilles tendon injury can result from flat feet. In this condition, muscle and tendon strains are possible when walking.
- Overextension of muscles or tendons.
The most common Achilles tendon strain or rupture occurs in people involved in sports such as:
- Sports dancing;
There is a high probability of injuring the Achilles tendon with a sharp, sudden movement.For example, a sprinter may suffer such damage at the start of a race. According to statistics, men over the age of 30 are especially susceptible to Achilles tendon injuries.
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2.Symptoms of Achilles Tendon Damage
Symptoms of Achilles tendon rupture or tendon sprain may include:
- Pain in the back of the leg and above the heel, especially when pulling the ankle or standing on the toes. With tendinitis, the pain may be mild at first, but gradually get worse. If you tear a tendon, the pain can be severe and severe.
- Tumor in the tendon area.
- Ligament stiffness.
- Click or pop during injury.
- Problems with flexing the foot or moving toes (with a complete rupture of the tendon)
To diagnose a tendon rupture or sprain, the physician performs a thorough medical examination. Your doctor may ask you to walk or run for an accurate diagnosis.
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3.Achilles Tendon Treatment
Minor sprains of the tendon can heal on their own. It only takes time and patience. To speed up healing, you can:
- Limit pressure on the leg. Distribute your body weight so that the good leg is carrying the bulk of the load. You may need crutches.
- Cool damaged area. If the Achilles tendon hurts, use ice to relieve pain and swelling (20-30 minutes, every 3-4 hours for 2-3 days).
- Apply a bandage. For Achilles tendon treatment, use an elastic bandage around the lower leg and ankle (this will reduce swelling).
- Place your foot on elevation (for example, a pillow).
- Take anti-inflammatory pain medication. Nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve pain and swelling. However, these drugs have side effects and it is best to consult your doctor before taking them.Usually, your doctor will recommend medications to take if your Achilles tendon hurts.
- Raise the heel. For Achilles tendon treatment, your doctor may recommend that you use a shoe insert to protect the tendon from further stretching.
- Perform exercises to stretch and strengthen the tendons as recommended by your healthcare practitioner.
Typically, these methods are effective in treating the Achilles tendon and help restore tendon function.However, for severe injuries, including a ruptured tendon, you will need 6-10 weeks to heal or even surgery to repair the tendon and remove excess tissue.
How soon will I feel better with an Achilles tendon injury?
Recovery time may take several months. It all depends on the severity of the injury. Treating the Achilles tendon does not mean giving up exercise completely. Try a new activity that won’t affect the injured leg too much.For example, swimming. Don’t rush things. Do not try to return to your previous level of physical activity until you can move your leg easily and freely, and feel pain in your leg while walking, running, or jumping. If you start to overload your leg ahead of time, it can result in increased pain and even disability.
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4.Prevention of tendon injury
To prevent Achilles tendon rupture or Achilles tendon strain, follow these simple guidelines:
- Always gently stretch and prep your leg muscles before and after your workout.
- Be careful when running uphill.
- Wear shoes with good foot support.
- Slowly increase the intensity of your physical activity.
- Stop exercising if you feel pain or tension in the back of your lower leg or heel.
90,000 characteristic signs, examination features, principles of treatment and rehabilitation
Achilles tendon (Achilles ligament) – the strongest in the human body. It is located on the back of the lower leg and connects the muscles to the heel bone.Thanks to this connection, the person flexes the foot at the ankle joint.
So, we stand on our toes, push off with our feet while running and jumping. The Achilles tendon plays a key role in a person’s ability to move freely, so damage to it leads to serious consequences, including disability.
Types of Achilles tendon injuries
Injury to the Achilles ligament occurs as a result of strong external influences or serious diseases that disrupt the structure of the fibers.Injuries are divided into several types.
Its main condition is a strong overstrain or a blow to a stretched ligament. This happens most often in professional sports or in car accidents.
Normal mechanical damage is preceded by microtrauma, which disrupt the structure of tissues.
A rupture of a healthy Achilles is very rare with a purposeful strong external impact – injuries at work, car accidents, falling from a height.
Acute inflammation of the Achilles tendon – Achilles (or Achilles tendonitis) is rare.
Usually this is a gradually developing process, in which neighboring anatomical structures are involved (the synovial bag of the ligament itself – achillobursitis, the tissue surrounding the tendon – peritendinitis, damage to the place of attachment of the ligament to the heel bone – enthesopathy).
Chronic inflammation is complicated not only by tendon tears, but also by the formation of a heel spur, a lump on the tendon or its calcification.Predisposing causes of Achilles tendonitis are:
- Age after 40 years, when tissue elasticity is gradually lost and the slightest awkward movement leads to microdamage and tissue inflammation.
- Uncomfortable footwear, especially in combination with overweight. The constant elevated position of the foot when wearing heels leads to a shortening of the ligament. If a woman abruptly switches to a flat sole, the Achilles tendon tears and becomes inflamed.
- Diseases with an autoimmune component affecting connective tissue: rheumatoid arthritis, bursitis after bacterial streptococcal infections (tonsillitis, scarlet fever).
Long-term inflammation leads to thinning of the fibers of the connective tissue, a decrease in its elasticity, which can result in injury.
The degenerative process is usually a consequence of chronic inflammation or persistent microtrauma of the ligament, which are observed in professional athletes.Degeneration of connective tissue also occurs with insufficient blood circulation in this area in people leading a sedentary lifestyle.
Age, some drugs (glucocorticosteroids, antibacterial drugs from the group of fluoroquinolones), especially when used uncontrolled, provoke a violation of the tendon structure, poor ecology, bad habits and many other factors.
Sometimes tendon rupture occurs spontaneously for no apparent reason. This is the result of a hereditary disorder of the structure of collagen fibers that form the basis of the ligamentous apparatus.
Depending on the type of injury, the following types of Achilles injury are distinguished:
- Open injuries – occurs when a cut or rupture with a piercing-cutting object, when all layers of tissue (skin, muscles) are damaged along with the ligament.
- Closed lesions are characterized by the preservation of the integrity of the skin. The ligament breaks when the calf muscle contracts excessively.
- Indirect rupture occurs as a result of muscle contraction. On the Achilles tendon, the load is applied through the muscle.Frequent situations leading to this: jumping in basketball or volleyball, when an athlete tries to jump on an extended leg, with a sharp bend of the foot (sliding off a step), falling onto an extended toe of the foot.
- A direct rupture of the ligament is the result of a blow directly into the area of the junction of the muscles of the lower leg with the heel bone (usually a strong blow with a blunt object).
In terms of the degree of damage, ruptures can be complete or partial, in terms of the time of occurrence – fresh or old.
Symptoms of trauma
Regardless of the cause, damage to the Achilles tendon has common characteristics:
- Pain. In case of an acute rupture, it occurs suddenly at the back in the lower part of the lower leg. Usually sharp in intensity. Only in some cases does a person experience minor pain sensations (with partial tear or low pain threshold). With stretching, inflammation or microtrauma, pain gradually increases, first after running and jumping, then after walking, and only at the last stage at rest.
- Characteristic sound. With a sudden complete rupture, you can hear the crackle or crunch of torn ligaments.
- Edema. It spreads from the foot to the entire surface of the lower leg, depending on the severity of the injury.
- Hematoma. It is characteristic of external damage when an impact leads to rupture of blood vessels.
- Restriction of movement. The degree depends on the type of injury. With a complete rupture, movement in the ankle joint is impossible, passive flexion causes severe pain. If the Achilles tendon is partially torn or stretched, the leg hurts when walking and especially when running or jumping.Sometimes unpleasant sensations during movement can exist for a long time. This indicates the development of a chronic degenerative process preceding the rupture of the heel tendon.
- Pirogov’s symptom is positive: the patient lies on his stomach and strains his calf muscles. On a healthy leg, the relief on the back surface of the lower leg is clearly visible, with an Achilles rupture this is not.
- With the development of enthesopathy or tendinitis, the tendon above the heel hurts if a person lies on his back for a long time with outstretched legs.
Any type of injury to the Achilles tendon leads to a violation of the gait, the person is limping or cannot step on the injured leg.
Diagnosis of ligament rupture
Any diagnosis begins with a detailed questioning of the patient about the circumstances of the injury. Sometimes, this alone is enough to think about damage to the Achilles.
On palpation, the doctor discovers a characteristic tissue failure at the rupture site. But Achilles tendon injuries are insidious and often lead to diagnostic errors.
Let’s consider possible situations when doctors have difficulties in establishing the correct diagnosis:
- It is believed that with this injury, the person is unable to perform plantar flexion of the foot. In fact, this is not always the case. If the patient has developed flexor muscles, the foot will flex even if the Achilles tendon is completely ruptured. Then the doctor, at best, will suspect a partial rupture of the ligament, which is treated conservatively.
- Next to the Achilles, there is another thin ligament – the plantar ligament, which can remain intact in case of injury.The traumatologist, on palpation, takes it for a part of the Achilles tendon and diagnoses an incomplete rupture.
In order to avoid these errors, there is an algorithm for diagnosing Achilles tendon rupture with the performance of several tests.
|Calf compression||In the position of the patient lying on his stomach, the calf muscles are squeezed, while in the healthy leg, flexion in the ankle joint occurs.If the calcaneus tendon is damaged, there is no flexion.|
|Needle||A medical needle is inserted at the junction of the aponeurosis of the gastrocnemius muscle and tendon. They ask the patient to move his foot and observe how the needle moves.|
|Knee Flexion||In the supine position, ask the patient to bend the knee. The foot will be bent more on the affected side.|
|Sample with sphygmomanometer||If you put a pressure gauge cuff on your lower leg, pump up the pressure to 100 mm Hg.Art. and move the foot, the pressure should increase to at least 140 mm Hg. Art. Less pressure indicates damage to the ligament.|
Two positive tests are usually sufficient for a correct diagnosis. In exceptional cases, instrumental examination is prescribed: X-ray, ultrasound, MRI.
Treatment of Achilles tendon injuries
In traumatology, there are two ways to treat tendon rupture: conservative and surgical.
Its essence lies in the complete immobilization of the ankle joint in a position with an extended toe. Then the ends of the damaged tendon are located close to each other, which facilitates their fusion. Immobilization methods can be different:
- Traditional plaster splint.
- Special orthoses or braces.
- Plastic plaster.
- Functional immobilization allowing partial support on the leg.
The duration of such treatment is at least 6-8 weeks.
But conservative treatment is not always successful. It has been proven that after it, repeated ligament ruptures occur much more often.
Surgery for plastics of the Achilles tendon is indicated for degenerative ruptures, with the formation of an extensive hematoma, which prevents the tight closure of the ends of the ligament, in old age, when the ability of tissues to grow together without outside intervention is significantly reduced.
Various anesthesia is used for pain relief:
- spinal anesthesia.
Operations are fundamentally different in the type of tendon suture, which is applied to the damaged area.
The tendon is sutured after providing access to it. To do this, an incision of up to 7-10 cm is made on the back of the leg. This is the most reliable method of surgical treatment, but it leaves a large scar on the skin.
The percutaneous suture is applied virtually blindly without cutting tissue layers. The disadvantage of this method is the likelihood of twisting the fibers of the ligament or damage to the sural nerve.
The described treatment is carried out only on fresh breaks, from the moment of which no more than 20 days have passed. If this period has passed, the injury to the Achilles ligament is considered old, it is no longer possible to sew its ends in a simple way. Then Achillesplasty is used with augmentation of a piece of connective tissue.
Complications after surgery
Surgical treatment is the preferred treatment for a ligament rupture in many cases. But, like any method, it has its complications:
- Infection. A frequent consequence of tears and their subsequent suturing. This is due to the poor blood supply to the damaged area and a small layer of overlying tissue. The use of modern self-absorbable suture materials reduces the frequency of infection.
- Tissue necrosis occurs when the overlying tissue flap is insufficient in size.This happens with extensive lacerations on the back of the lower leg.
- Formation of rough scars that cause discomfort, up to soreness.
- Re-rupture of the tendon.
- Damage to the sural nerve.
- Impaired limb mobility, which occurs with repeated damage to the tendon.
Prevention of complications of the postoperative period depends not only on the skill of the surgeon, but also on the patient’s compliance with all recommendations for rehabilitation after surgery.
Recovery from trauma
The success of treatment depends not only on professional treatment in the acute period of trauma, but also on rehabilitation at home. The modern approach involves the use of various exercises, physiotherapy procedures and physiotherapy exercises even at the time of immobilization. They are carried out only under medical supervision.
Then, after removing the splint, the patient is recommended to perform various exercises aimed at stretching the muscles of the lower leg and improving the elasticity of the Achilles tendon.Their main task is to strengthen the ligament and muscles in order to avoid re-rupture. Various massages (regular, pneumatic and others) help to restore function well. In terms of time, this process can take from 60 to 180 days.
Achilles tendon injury is always serious and requires a lot of effort from a person to recover. Successful recovery requires timely access to qualified help, the implementation of all recommendations and the exclusion of self-medication.
Source: https: // TravmoVed.com / rastyazheniya / razryv-ahillova-suhozhiliya /
Recovery from ruptured Achilles tendon
The Achilles tendon does a tremendous job of providing foot mobility. It connects to the gastrocnemius muscle and is designed to absorb possible traumatic effects. Such influences often occur when running, jumping, especially if a person is overweight.
Unable to withstand the load, the tendon can rupture completely or partially. The rupture is not only painful in itself, but also requires orthopedic treatment, as well as long rehabilitation after the ruptured Achilles tendon to restore the normal functioning of the foot.
Achilles tendon rupture can be treated conservatively, but in the event of a complete rupture, surgery is necessary. In case of a tear, it is enough to immobilize the leg with a plaster splint.
Naturally, a person loses the ability to walk normally, he has to use crutches or a cane, but at the initial stage, immobilization of the foot is a prerequisite for the tendon fusion.
Wearing a plaster cast for this injury is quite long – up to 10 weeks.
The rehabilitation program after rupture of the Achilles tendon takes place in several stages, depending on the degree of healing of the injury. The first stage, while the leg is still in a cast, does not involve active physical exercise, is aimed at improving blood circulation in the injured limb and preventing edema. During this period, light exercise and massage are indicated.
After removal of the cast, a careful restoration of joint mobility begins. If you are overweight, it is imperative to lose at least a little to reduce the load on your leg.During this period, you need to start walking, for about 20-25 minutes a day, and continue to massage to prevent swelling. You can consult a competent chiropractor.
When the walking speed is already about six kilometers per hour, you can move on to slow running and exercises for multi-plane foot movement.
What threatens the refusal of rehabilitation
Important! Failure to rehabilitate after Achilles tendon surgery can have a number of dire consequences.It can be a joint contracture, that is, a significant limitation of the foot’s mobility, which will lead to a change in gait.
Many people, hoping that the injury will “heal by itself”, until the end of their lives are unable to restore the mobility of the injured joint. Complications are possible in the form of muscle atrophy, the occurrence of an adhesive process at the site of the rupture.
One of the most serious consequences can be deep vein thrombosis, the complications of which are life-threatening.
How to do the exercises correctly – independently or with a specialist?
At the initial stage, while the limb is in a cast, and the first time after its removal, specialist supervision is simply necessary.Any exercises should be coordinated with the attending physician, and, if possible, engage in under the guidance of an exercise therapy instructor. The task of the specialist is to correctly dose the physical activity and monitor the correctness of the exercises.
In the future, when it becomes clear that the healing process is proceeding normally, you can practice on your own, referring to the instructor to clarify the questions that have arisen. If there is no way to study with a specialist, you should consult a doctor to recommend sources for classes, and carefully monitor your condition.
Complexes of exercises for rehabilitation after rupture of the Achilles tendon can be different, depending on the period of time that has passed after the operation.
The first complex is the most gentle and is used in the first month and a half after the injury. You can start doing the exercises one week after surgery or the application of a plaster cast.
Since gypsum seriously restricts movement, this complex is aimed primarily at increasing blood circulation in the affected limb.
All exercises are done while sitting or lying down, without much stress and avoiding pain.
- Flexion and extension of the toes in a sitting position.
- Lie on your back, legs raised and bent at the knees, simulate cycling.
- Lie on your stomach, bend your knees, as if throwing them back, alternately.
- Lie on your back, legs straight, try to raise your pelvis, leaning on your shoulder blades and heels.
- Sitting on a chair, press the plaster with the sole without much tension.
Attention! Each exercise is performed for no longer than three minutes.
The second complex is designed for a period from one and a half to three and a half months after the operation. It should be started after the plaster has been removed. During this period, gentle walking is the best exercise. To protect the injured foot from repeated damage, you can make a heel pad in shoes from soft materials – felt or felt.
The thickness of the lining can be varied, but not less than one and not more than four centimeters.You need to walk slowly and carefully, especially in winter. The stride length should initially be no more than the length of the foot, subsequently the stride length can be gradually increased.
At home, you can build yourself a semblance of exercise equipment from objects that resemble paperweights or the pedal of a sewing machine with a foot drive. Rocking the foot with support on such objects stretches the tendon well without injuring it. Naturally, this exercise is performed in a sitting position. Add the following to the exercises from the first set:
- Sit on a chair with your feet on the floor.First, carefully raise your heels with support on your toes, then completely rest your entire foot on the floor. Raise the socks with support on the heels and return to the starting position again.
- When the previous exercise is easy, we introduce the load. Sit on a chair, feet flat on the floor, put dumbbells weighing up to 5 kg on your hips. Raise your heels while overcoming the weight.
- Sit on a chair placed in front of the wall, raise your leg and rest against the wall, with slight tension. Perform alternately with a healthy and injured leg.
- Gradually begin to stand on your toes with your heels raised.
Examples of possible exercises
The third complex is performed in the pool when at least two months have passed since the operation. In water, body weight decreases, so movements can be performed with greater amplitude. The main exercises of this complex:
- Perform side lunges in the water while holding onto the handrail.
- Standing in the water, perform toe raises.
- Walking in water on toes.
- Walking with a roll from toe to heel and vice versa.
The fourth complex can be described as restorative, it is performed after 3.5-4 months after the injury and is aimed at normalizing the mobility of the foot in the same volume as before the injury. During this period, the load is approaching sports, so you should only switch to it when the previous sets of exercises are given without difficulty.
The complex includes:
- Walking on a treadmill, normal and backward.
- Climbing on a stepper (initially holding on to the support when lifting on an injured leg).
- Jumping rope with support alternately on a healthy and injured leg.
- Squats, holding the support, feet completely on the floor.
Exercises during the rehabilitation period after rupture of the Achilles tendon improve blood circulation in the leg, faster fusion of the tendon itself, and reduce swelling. The rehabilitation period lasts on average about six months.Provided that all points of the program are carefully followed, it is possible to guarantee complete restoration of foot mobility in the absence of pain.
Finally, you can test for Achilles tendon rupture:
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How to quickly recover from a ruptured Achilles tendon
Achilles tendon rupture is a common injury among athletes that can cause many serious problems.Oftentimes, a break occurs during a fast run or jump. Proper rehabilitation after a ruptured Achilles tendon will help you recover quickly and avoid future health problems.
Causes of rupture and its types
Achilles tendon rupture occurs in the following cases:
- Direct blow to the taut tendon. This happens most often during sports. With such an injury, doctors diagnose a closed gap.
- Indirect injury resulting in a closed-type rupture.Such damage can occur as a result of a sharp dorsiflexion of the foot when falling from slippery steps, a sharp contraction of the lower leg muscles when extending the leg, for example, as a result of a jump or fall from a height when the toe is in an extended state.
- The Achilles tendon can be injured when exposed to a sharp object, such as from a knife wound. In this case, an open gap is formed.
Poor quality shoes, short tendon, overweight, age-related and degenerative changes caused by overload of tendon tissue can be the cause of rupture of the Achilles tendon
When the Achilles tendon ruptures, a sharp, severe pain occurs, which in most cases is accompanied by a clicking sound.After the rupture, the patient is limp, unable to stand on the tips of the injured leg or push them down against the support. At the site of the rupture, you can feel a depression 2-5 cm in size above the heel bone.
Achilles tendon rupture may be partial or complete. Partial rupture can be treated conservatively by applying a plaster cast. With a complete rupture, an operation is performed to suture the tendon.
Surgery is the most effective and commonly used treatment for ruptured Achilles tendon.
Rehabilitation period and recovery time
Treatment and rehabilitation after rupture of the Achilles tendon is a long and difficult process. After the operation, a plaster cast is applied to the patient for six weeks: the first three weeks up to the upper third of the thigh, then the splint is replaced with a plaster cast up to the knee. Provided that all the doctor’s instructions are followed, most patients return to their normal lifestyle in 4-6 months.
Features of the first stage of recovery
The rehabilitation period after Achilles tendon surgery has three stages.The first lasts about six weeks.
During this period, it is necessary to create optimal conditions in the operation area to improve blood and lymph circulation in the tissues; careful, moderate activation of the patient and to prevent complications after surgery.
For this, within 8-9 days after the operation, the injured leg must be kept in an elevated position on the splint – this improves the venous outflow.
A set of exercises in the first stage of rehabilitation
In the first stage of rehabilitation after rupture of the Achilles tendon, patients should perform general developmental physical exercises that cover all muscle groups.They need to be done on the second day after the operation. Lying on the bed, the patient must perform active movements with the toes.
On the 9-10th day, the task is to avoid atrophy and preserve the contractile function of the triceps muscle of the leg. The patient walks on crutches without leaning on the injured limb and performs contraction of this muscle.
Three weeks after the operation, when the splint is replaced with a plaster cast up to the knee, active movements in the knee and hip joints must be performed to restore movement in them and functional rehabilitation of the thigh muscles.
Second stage of restoration
The second period of injury recovery begins after the removal of the plaster cast and ends approximately three months after surgery. Rehabilitation after stitching the Achilles tendon at this stage should eliminate such negative phenomena as contracture of the ankle joint, hypotension and hypotrophy of the triceps muscle of the leg, and gait disturbance.
In the second stage of recovery, classes in the pool are effective, where patients perform the following exercises:
- calf raises;
- half squat on toes;
- toe walking;
- swimming with fins.
Physiotherapy at the second stage of rehabilitation
To eliminate complications after surgery, you need to perform foot movements in warm water: flexion, extension and circular movements in the ankle joint, rolling the feet of a ball and a gymnastic stick.
Approximately 2.5 months after the operation, the patient can walk with a stick. It is necessary to train the support on the toes of both feet and gradually shift the center of gravity of the body to the injured leg. Correct walking is practiced until the foot roll function is fully restored.
The third stage of restoration
Physical rehabilitation in case of rupture of the Achilles tendon at the final stage should ensure maximum restoration of the range of motion. If the patient follows all the doctor’s recommendations, then after this recovery period he returns to his normal lifestyle, athletes can gradually begin the training process.
Training and recovery exercises at the final stage of rehabilitation
The rehabilitation process at this stage includes step-down exercise, that is, descending steps.Sports loads are allowed only after the patient can perform ten toe raises, descend stairs backwards, and the joint becomes fully mobile.
Patients should then walk on the simulator. Then you can start running at a slow pace: first, only on a straight surface, and over time add running to the side and zigzag.
Complications after surgery
Following surgery for ruptured Achilles tendon, the following complications may occur:
- Severe painful scars as a result of insufficiently good surgical technique or poorly conducted postoperative period.They can also occur when the tendon ruptures again. This can lead to limited movement of the joint, constant pain, disruption of the normal walking process.
- Re-rupture can occur due to a violation of the postoperative regime or with excessive stress on the injured leg. This complication requires a second operation, the rehabilitation process after which is more complicated and time-consuming.
- Damage to the sural nerve, manifested by numbness along the edge of the foot.This complication does not cause much discomfort or pain.
- A neuroma of the foot is a benign neoplasm that can be treated fairly well with medication. The discomfort that this disease causes can be eliminated with comfortable shoes and special linings.
If you adhere to the doctor’s recommendations in the postoperative and rehabilitation periods, you can avoid complications after rupture of the Achilles tendon and return to your usual active lifestyle.
How is rehabilitation done after an Achilles tendon rupture?
Rehabilitation after rupture of the Achilles tendon takes a fairly long period of time and is carried out under the strict supervision of the attending traumatologist.
The Achilles tendon is the largest tendon in the human body. It connects the calf muscle to the heel bone.
Its function is aimed at stimulating the movement of the heel area when walking or running and helps to raise the whole body on the tiptoe, produces plantar flexion.
Severe stretching leads to tears or possible complete rupture.
The following situations are considered especially dangerous:
- With a direct impact on a taut tendon. More often this happens while playing football or during physical activity.
- A tear is made with a strong contraction of the lower leg muscles, bringing the leg into a straight state. Observed when a non-bunched jump is being executed.
- When the foot is suddenly bent forward.There is such an injury when a person slips on the steps.
Tendon ruptures are divided into open (wound with a sharp object) and closed (damage occurs due to falls, impacts, etc.). Violation of integrity occurs 5 cm from the area of connection with the heel bone. It is due to poor blood supply in this place.
The main signs of rupture of the Achilles tendon. Trauma can be determined by the following complaints from the victim:
- Feeling of the impact in the lower leg area.
- During the injury, a specific dry crunch was heard.
- There is a piercing pain sensation when trying to move the leg, which leads to a violation of the gait, lameness is noticeable.
At the site of the injury, edema and hematoma are observed, which increase in size over time. A person cannot stretch the foot and fully step on the leg in an upright position of the body. On palpation, a depression is felt at the place of rupture.
First aid.It is necessary to give the victim a comfortable horizontal position, freeing the injured lower limb from the load. Remove tight clothing from the damaged area and apply cold. It is forbidden to massage or bandage. An urgent need to go to a medical institution for examination and treatment.
To determine the gap, MRI is done, the damage is visually diagnosed, an ultrasound scan and X-ray are prescribed. If it is not possible to conduct the survey data, then it is determined using special tests:
- Calf compression.The medical professional squeezes the muscles of the lower leg with his hand, and the foot is extended. It is performed on both legs, and the result obtained is compared.
- The needle test is performed using a thin injection needle that is inserted into the tendon plate at the site of attachment to the heel bone. Then it is necessary to move the leg, and the gap is determined by the deviation of the needle.
- Knee flexion test. The person lies on his stomach and bends the lower limbs at the knee joints (towards the back).The toes of the injured foot are located lower than those of the healthy one.
- Copland test. The patient also lies on his stomach. The sphingmomanometer cuffs are put on the middle third of the lower leg and the pressure is injected up to 100 mm Hg. Art. in a relaxed state of the limb. Then the doctor begins to move the foot and observes the monitor. If the pressure increases, the muscle-tendon complex is intact. If the indicator does not change, this means a violation of the integrity of the fibers.
Treatment of ruptured Achilles tendon.There are 2 types of treatment – conservative and operative. The first is aimed at preventing the deterioration of human health and the onset of natural recovery. A plaster cast is applied to the patient to immobilize the limb for 2 months. This position allows the torn edges of the tendon to gradually grow together.
It is forbidden to wet your leg at all times, remove the bandage yourself or completely remove the cast. Only as directed by a doctor, after complete fusion of the tissues, the nurses will carefully remove the injured limb from the splint.
Surgical treatment consists of surgical intervention under certain anesthesia. In a normal operation, the skin is dissected on the back of the leg measuring 10 cm, the ends of the torn tissue are sewn together with a special thread and a suture is placed on the incision. At the end of the procedure, a plaster cast is applied.
After the end of the surgical treatment, the rehabilitation period begins. It always takes place under the supervision of the attending physician. The patient must strictly follow all the doctor’s instructions, and then the rehabilitation period will lead to the complete restoration of the functions of the Achilles tendon.
Rehabilitation after tendon rupture. After surgical treatment, a recovery period begins. The rehabilitation program begins 1-6 weeks after the operation.
In the first 7 days, it is necessary to create complete rest of the damaged part of the body. Pillows should be placed under the leg, giving this an elevated position, which helps to reduce swelling.
Further, under the supervision of a specialist, it is necessary to load the injured limb in a strict dosage with a gradual increase in physical movements.
Rehabilitation after a tendon rupture is divided into 4 periods and includes the following activities:
- The phase of coalescence and protection – duration is about 6 weeks. Strict monitoring is carried out for the swelling of the affected area and pain. The patient makes limited movements and performs the first muscle-tendon loads. Over time, it is allowed to walk only with crutches under the supervision of a surgeon. Cryotherapy is prescribed.
- Early mobilization – occurs from 6 to 12 weeks after surgery.An axial load is applied, first with crutches, and then in special shoes without support. Medical professionals massage the damaged area. After the surgical wound has completely healed, exercise on an underwater treadmill is recommended. The speed is selected individually so as not to create a large load on the body. The gait is normalized. Closer to week 9, exercise on a stationary bike is allowed. It is necessary to walk on an incline (30 °).
- The period of early strengthening – from 12 to 20 weeks.The goal is to fully achieve normal range of motion. The patient adapts to the daily lifestyle without painful sensations during independent movement on a plane with different angles of inclination.
- Beginning of sports activities – rehabilitation activities continue from 20 to 28 weeks of recovery. Full preparation of the body for the resumption of sports. Resistance exercises strengthen the muscles of the body and develop muscle endurance. Add a straight run with gradual physical techniques.With the correct recommendations, after 8 months, the body is completely restored.
Rehabilitation after a tendon rupture takes a long time and requires a lot of physical and psychological effort. All physical activity and recovery time must be agreed with the attending physician. It must be remembered that after the completed course of treatment, there is a high risk of re-injury to the Achilles tendon.
Source: https: // spina-health.com / reabilitaciya-posle-razryva-axillova-suxozhiliya /
Recovery after surgery for ruptured Achilles tendon
Achilles tendon (Latin tendo calcaneus) or heel tendon is the most powerful and strongest tendon in the human body. Despite this, it is one of the most commonly injured tendons.
The proximal part originates at the confluence of the soleus and gastrocnemius muscles, the zone of its distal fixation on the posterior surface of the calcaneus tubercle.
Achilles tendon rupture is usually complete. More often, ruptures occur with a sudden sharp load on the tendon at the start of sprinters, at the moment the leg is lifted from the ground during a jump, with a sharp dorsiflexion of the foot – a fall from a height. Direct injury from a cutting object may result in partial damage to the tendon. The patient complains of pain in the Achilles tendon area.
At the moment of injury, there is a sensation of a blow to the tendon. On the back surface of the lower third of the leg, hemorrhage, edema occurs.A sinking is found in the area of the gap. There is no plantar flexion of the foot – the patient cannot stand on his toes.
Most often, the tendon breaks 4-5 centimeters from the place of attachment to the heel bone.
After surgical treatment
From the first days, therapeutic exercises are prescribed, aimed at improving blood circulation in the operation area, preventing adhesions, preventing stiffness in immobilized joints and muscle atrophy.
The classes include general toning exercises for the upper limbs, shoulder girdle and trunk (static and dynamic), exercises for the non-operated lower limb. Specific exercises include wiggling toes, ideomotor exercises, and movements in the hip joint.
From 3-4 days isometric tension of the triceps muscle of the lower leg is required when attempting to plantar flexion of the foot and extension in the knee joint. This exercise should be repeated many times throughout the day.
3 weeks after the operation, the plaster cast is replaced with a plaster boot for 3 weeks, the foot is given a less bent position.
The main task of therapeutic gymnastics at this stage is to restore the amplitude of motion in the knee joint, functional recovery of the thigh muscles and prevention of atrophy of the leg muscles.
Exercises are performed in the initial position, lying on your back, on your stomach, on your side, sitting on a chair. In addition to general tonic exercises, special exercises are carried out: dynamic exercises with resistance, static efforts for the muscles of the thigh, isometric tension of the leg muscles, ideomotor exercises.
After 6 weeks. the plaster cast is removed, and therapeutic gymnastics is aimed at restoring movements in the ankle joint, strengthening the muscles of the lower leg, and preparing for walking.
In the first days after the removal of immobilization, movements in the ankle joint are performed carefully, in light conditions: lying and sitting on a chair (a sliding plane is brought under the foot). Exercises are carried out independently, with self-help and the help of a rehabilitation therapist.
From 6 to 12 weeks, postoperative rehabilitation is characterized by full axial load, increased mobilization of the limb and the beginning of stretching exercises.First, full axial loading is allowed in the brace and with crutches, and then the patient is allowed to use casual shoes and no crutches.
At this stage, it is advisable to place a heel cushion in the shoe, which facilitates the transition from the brace (usually by this moment it limits dorsiflexion to 20-30 degrees of equinus) to ordinary shoes. The height of the heel is gradually reduced in accordance with the progress of the range of motion. Crutches and a heel pad are stopped only after the patient regains normal gait.
Under the condition of complete epithelialization of the postoperative wound, walking on an underwater treadmill is possible. The need for this simulator is due to the fact that it allows you to develop a normal gait.
Walking on an underwater treadmill with the body submerged in water to the level of the nipple line allows to reduce the axial load on the limb by 60-75%, and when immersed in water to the waist level – by 40-50%.
The active range of motion in all planes is continued without restrictions, and passive movements are limited.Normal walking is sufficient to restore functional range of motion, and stretching exercises for this purpose should be avoided. As a rule, at this stage of rehabilitation, the range of motion is already at an acceptable level.
Also at this stage, a careful isometric inversion and eversion are started, which gradually progress to the use of elastic bands for resistance.
It is advisable to restore the strength of the leg muscles and the range of motion on a special simulator, in which the patient’s foot is fixed in a special device that allows movement in all planes.
After an adequate amplitude of foot movement has been achieved, they move on to strengthening the two main flexor muscles (mm. Gastrocnemius and soleus).
At 6 weeks after the operation, active plantar flexion of the foot with resistance is performed in the position of flexion of the limb in the knee joint at a right angle.
From the 8th week, plantar flexion with resistance begins to be performed with the leg extended at the knee joint.
Plantar flexion with resistance
Performed from 6 weeks after surgery.The patient sits on the edge of the couch with the legs bent at the knees hanging down. This position of the legs reduces the tension on the Achilles tendon. A loop of elastic tape is put on the foot of the sore leg and stretched.
At this stage, rehabilitation is supplemented with other exercises. Plantar flexion with resistance is performed on various strength training equipment. They continue to exercise on a stationary bike, gradually increasing the load on the tarsus and shifting the point of application of the pedals on the foot closer to the toes.
Plantar flexion with resistance
Performed from 8 weeks after surgery. This exercise is performed while sitting on a couch, with the leg straightened at the knee joint lying on the couch: in this position, the load on the Achilles tendon is higher. A loop of elastic tape is put on the foot of the trained leg and stretched.
Other exercises are used at this stage of rehabilitation. Plantar flexion with resistance is performed on various strength training equipment.They continue to exercise on a stationary bike, gradually increasing the load on the tarsus and shifting the point of application of the pedals on the foot closer to the toes.
Strength training exercises
To restore plantar flexion and proprioception, it is necessary to use walking “back and forth” on a treadmill.
The patient stands on the treadmill backwards, i.e. with the back of the head to the control panel, holding the handrails with his hands. Set the speed of the track at 1-2 kilometers per hour and begin walking backward with the roll of the foot from the toes to the heel.In this case, the patient should fully straighten the leg at the knee at the moment when the foot is completely on the treadmill.
Step-up exercises with visual control
Start the exercise with a low step (10 cm high). The patient stands in front of the step on the floor and takes a slow step with his good leg forward, rising to the step. At the same time, the body weight is kept on the sore leg, which will also train balance.
There should be a mirror in front of the patient, so that the patient can look at himself from the side, controlling the position of the feet and hips – it is very important to ensure that when going up the step, there is no sideways collapse on the sore leg.Then they return to the starting position and repeat the exercise.
If the exercise is performed correctly, then the step height is gradually increased (15 and 20 centimeters).
It is necessary to restore not only muscle strength and range of motion, but also proprioception, without which effective muscle interaction is impossible. For this purpose, exercises on movable supports such as BAPS are useful – a support for biomechanical training of the ankle joint. The top surface of the stand is hard and flat, while the bottom is soft and shaped like a sphere.
Exercises on movable supports BAPS begin in a sitting position, then move on to training proprioception, standing on two legs, then – standing on one leg, and gradually complicate the exercise by throwing a ball against a wall or by resistance.
Training of proprioception and balance on movable supports can be supplemented with strength exercises, which are also performed while standing on a platform on two legs, and then gradually increase resistance and move on to exercises while standing on one leg.
From 12 to 20 weeks after the operation, there is a complete restoration of the amplitude of active movements, the strength of the flexor muscles and symmetrical balance on both lower extremities.
It is believed that the normal force of plantar flexion corresponds to the patient’s ability to rise on the toe of one leg at least 10 times. However, the patient must first demonstrate the ability to rise on the toes of both feet, and then the conditions of this exercise become more difficult.
Restoration of plantar flexion strength: start with bilateral flexion on the simulator in a sitting position (to eliminate the need for balancing) and gradually increase the exercises until the unilateral toe lift at the edge of the step.
Step-down exercises (descending steps) are performed according to a progressive type, gradually increasing the height of the step (10, 15 and 20 cm). Proprioception and balance training is performed again according to the progressive type (both legs – one leg). In this case, not only the already described BAPS platforms can be used, but also trampolines, swing stands, etc.
To further restore the strength and endurance of the lower leg muscles, isokinetic exercises are used, which involve movements with accommodating resistance at a fixed speed.
Consequently, thanks to this principle, the maximum possible muscle contraction occurs with a simultaneous full amplitude of movements (in this case, active-passive, since in the extreme positions the movements are carried out at the expense of the simulator).
Isokinetic plantar and dorsiflexion of the foot
The patient sits in a biomechanical system chair with an isokinetic mode of operation such as HUMAC NORM and performs dorsal and plantar flexion of the foot.
Exercise trains muscle strength, and the indicators allow you to evaluate the effectiveness of the rehabilitation program.It is based on the principle of adjustable and accommodating resistance to movements at a constant speed.
After the gait is restored, the full amplitude of passive movements and normal muscle strength are obtained, they begin to run on the underwater treadmill, immersing the patient in water to chest level. Exercise on such a simulator allows you to reduce the load by reducing body weight.
The volume and intensity of the exercises that the patient performs at home are adjusted by the rehabilitation therapist in accordance with the progress achieved.
The criterion for the transition to the next phase is, among other things, the restoration of the ability to balance on one leg, which is compared with the contralateral one. In this case, both IMOOVE and COBS simulators in testing mode and NeuroCom devices can be used.
From 20 to 28 weeks. After the strength and function of the triceps calf muscle have returned to normal, the patient proceeds to the next phase of rehabilitation, the goal of which is to return to higher than daily physical activity.In general, all rehabilitation measures are aimed at preparing a springboard for the resumption of sports.
At twentieth week postoperatively, isokinetic testing is performed against the contralateral limb of plantar flexion, dorsiflexion, inversion and eversion. It is the isokinetic assessment of strength that is preferred, since it is much more accurate than manual isometric examination.
Isokinetic assessment allows the therapist to obtain objective data on the strength, effectiveness and endurance of the leg muscles, which can be used not only as a criterion for the transition to the next phase of rehabilitation, but also for monitoring the patient’s status.
If the results of the isokinetic assessment are at least 75% of the indicators of the contralateral limb, and the patient can rise on the toe of the injured limb at least 10 times, then it is allowed to start running forward on the treadmill. The running program should also be progressive, starting at low speed and short distances.
The increase in the intensity of the load is regulated by the patient’s subjective sensations, the running itself should be painless.
They continue exercises with resistance, development of amplitude and freedom of movement, as well as isokinetic exercises that strengthen the strength and endurance of the muscles responsible for plantar flexion, dorsiflexion, inversion and eversion.
In accordance with the requirements of the sport, they start running, starting from a simple straight-line run on a flat surface and then, according to the patient’s feelings, complicate the exercises by running sideways, running in a zigzag pattern, according to the figure of figure 8, with acceleration and deceleration. These exercises can be supplemented with elastic resistance.
Running with side steps with resistance
The patient puts a loop of a long elastic band around the waist, the other end of which is fixed to the wall.Run sideways with side steps, stretching the tape. They return to their original position with the same additional steps.
Standing balance training on a roller (proprioceptive training)
A loop about 1 meter long made of elastic linen is attached to the wall at a height of 15 centimeters from the floor.
The patient stands facing the wall 70 centimeters from it, the loop is put on the healthy leg, and the sick leg is on the cushion. In this case, the sore leg is slightly bent at the knee.They start swinging the healthy leg back and sideways, trying to maintain balance on the injured leg.
At the start position, the belt tension is moderate. When exercising, keep your back straight and your legs extended at the knees.
Difficult proprioceptive training (balance training while standing on a swinging platform)
The patient stands on a sore leg on a swinging platform, the healthy leg is bent at the knee.