CHRONIC ACHILLES TENDON RUPTURE
Chronic Rupture of the Achilles Tendon
What is it?
When the Achilles tendon rupture is not diagnosed early on, the ends of the tendon begin to separate (retract). Walking and pushing off with the foot become increasingly difficult. There are however other muscles in the leg which try to compensate for the loss of the Achilles and the leg muscle (the gastrocnemius muscle), but these are never sufficient to maintain the power and strength of the leg. Due to the extra work load on the other muscles of the leg which try to compensate for the weakness, the toes begin to curl and may become permanently deformed. Treatment of a chronic rupture of the Achilles tendon can be initiated with the use of a brace, but ultimately, surgery should be performed.
While a brace never restores a full function of the leg and there is always weakness, it does permit some increased strength in push off since a spring is attached to the brace which fits inside the shoe. Surgical treatment is however ideal, and should be e performed as soon as possible after the diagnosis is made to maximize the return of strength before the tendon retracts too far. The type of surgery performed depends on the size of the gap between the tendon ends and the extent of the separation that is present. If the separation is minimal, then the tendon ends can be stitched together as we do for an acute rupture of the Achilles tendon. If the separation is more significant, then other procedures need to be performed including the use of a special Achilles tendon graft (an allograft tendon, obtained from the tissue bank), a tendon transfer using one of your own tendons, or advancing a strip tendon from the gastrocnemius muscle to replace the gap in the Achilles tendon. The tendon transfer uses the second strongest muscle in the leg after the gastrocnemius, which is the muscle to the big toe (the flexor halluces longus).
General Recovery Facts
The goal of surgery is to return you to full healing and strength of the tendon in as short a time as possible. You will need to use crutches for 2 to 3 weeks after surgery, and then as soon as the stitches are removed, you will begin walking in a removable boot. No cast is used for your recovery. There is hinge on the boot which will allow the foot to go downwards (plantarflexion) but will limit the ability of the foot to go in an upward direction (dorsiflexion). Walking and exercise are very important after the surgery and a careful physical therapy program which I have developed will be necessary. If the leg is involved, then you may begin to drive at 5-7 days after surgery. Strength of the leg after the reconstruction is good, but unfortunately, never normal. You will be able to push off with one leg, play tennis and exercise, but it may be difficult to run. You will need to work hard in physical therapy to regain strength in the leg.
Before & After Pics
3 months post op
Specific post-operative recovery
- Foot is wrapped in bulky bandage with plaster preventing movement of the leg.
- Elevate the leg, and take pain medication regularly.
- Expect numbness in foot 4-12 hours then pain, and bloody drainage is expected.
- Do not allow foot to hang down.
- First follow-up in the office.
- Dressing changed, and boot is worn in slight equines.
- Plantarflexion (downward movement of foot) is allowed. There is a block to upward movement of the ankle.
- Start full weight-bearing in boot.
- If incision is dry, swimming is permitted, and walking in a pool without support is allowed.
- Gentle exercise on bicycle permitted preferably with boot.
- By 6 weeks the boot comes up to a neutral position.
- Start physical therapy under supervision.
- Start biking without boot.
- More vigorous exercise with physical therapist.
- Can discontinue use of boot. Physical therapy and exercise is essential for recovery and will last for two months. You will need to do exercises for strengthening every day for two further months.
- It is useful to have a lift put on the heel of the shoe for two months until the strength has returned.
- An orthotic arch support is important for recovery. The orthotic support will be made in our office following a computer analysis of the pressure of the foot.