Rupture, or tearing, of the Achilles tendon is a common condition. This typically occurs in the unconditioned individual who sustains the rupture while playing sports, or perhaps, from tripping.
There is a vigorous contraction of the muscle and the tendon tears. The patient will often describe the sensation that someone or something has hit the back of the calf muscle or the sound of a gunshot. While it is possible to treat this ruptured tendon without surgery, this is never ideal since the maximum strength of the muscle and tendon never returns. Surgical correction of the ruptured tendon is absolutely recommended.
The surgery is performed in order to regain the maximum strength of the Achilles, as well as the normal pushing off strength of the foot. The strength of the muscle depends on establishing the exact correct tension between the muscle and the tendon, and the only way that this can be set is by accurately repairing the tendon ends.
There are old fashioned techniques for repairing the tendon which require very long incisions on the back of the leg almost 20-25 cm long. These are complicated and associated with a very high incidence of infection in the skin after surgery. This problem with the skin and healing in fact has in the past led surgeons away from surgical methods of treatment.
Fortunately, with medical advances and studies are now perform this procedure along the inside of the leg away from the nerves and vital structures with a limited incision confined purely to the rupture site usually no longer than 5 cm in addition I do not place any of my patients on their stomach (prone position) hence avoiding multiple anaesthetic complications and the surgery is performed with the patient flat on their back.
Instead of a cast with the foot in planter flexion (toes pointing downwards), followed by serial cast changes until the foot is at 90°, I set the foot at 90° and allow weight-bearing in the cast from 2 weeks onwards hence stimulating the calf muscle and protecting the tendon repair..
This cast is removed at 6 weeks as any longer will lead to tremendous weakness and atrophy of the calf muscle, which can often become permanent.
Once the cast is removed patient is converted to a range of motion Moon boot encouraging full motion of the toes pointing downwards but protecting any upward movement of the ankle past 90° whilst undergoing physiotherapy.
This is far more accurate surgery, the tendon repair is easier to recover from, and the complication rate of this type of surgery is much lower.
This treatment has made a huge difference in the recovery process, and therapy and exercises are begun soon after surgery.
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 crutca
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 10 days after surgery, and then as soon as the swelling has subsided, you will begin walking on the cast.
When converted to the range of motion Moon boot 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 in conjunction with physiotherapist and Biokineticist’s will be necessary.
You may experience a variety of sensations whilst in the cast consisting of sharp shooting, dull aches, electric shocks, throbbing, sensation of itching and these are all normal and you should not panic.
You will also be placed on DVT prophylaxis as there is a risk of blood clots shooting to the lungs with this procedure for a period of 6 weeks.
hes for 10 days after surgery, and then as soon as the stitches are removed, you will begin walking in a removable boot. 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 incision is dry, swimming is permitted .
⦁ Gentle exercise on bicycle permitted preferably guided by physiotherapist.
⦁ By 6 weeks boot comes up to a neutral position and must be used for 6 weeks.
⦁ Start physical therapy under supervision with Institute protocol.
⦁ More vigorous exercise with physical therapist.
⦁ Can discontinue boot at 8 to 12 weeks and use a shoe with a slight heel lift glued on to the sole of the shoe .
⦁ Flat running on treadmill by 6 months.
⦁ Cutting sports by 9 months to a year.