What Causes Achilles Tendon Rupture & How is it Repaired?

Achilles Tendon Repair surgery is recommended to people when they have had an Achilles tendon rupture or tear. The Achilles tendon or heel cord, is also known as calcaneal tendon, is a thick band of tissues that connects the two muscles of the back of the leg, soleus and gastrocnemius to the bone of the heel of the foot, called calcaneus. The Achilles tendon is the largest and strongest tendon in the human body. It allows the foot to point downward. This movement is necessary to push off the ground to walk, jump, run, or stand on the toes.

The Achilles tendon is one of the most commonly injured tendons in the body. Sudden forceful up or down movements can tear or rupture the Achilles tendon. Achilles Tendon Rupture most commonly occurs in the middle-aged male athlete. Injury often occurs during recreational sports that require bursts of jumping, pivoting, and running. Most often these are tennis, racquetball, basketball, and badminton. Achilles Tendon Rupture injury is more common in people who have preexisting tendinitis of the Achilles tendon. Other risk factors for Achilles tendon rupture are aging, taking medications such as corticosteroids and some antibiotics including levofloxacin and ciprofloxacin, being a male, having an increased BMI, smoking, having peripheral vascular disease and diabetes.

Achilles tendon rupture can be complete or partial. The patient will often feel squeezing or hear POP when the tendon ruptures. Pain is felt in the back of the ankle and feels like someone has kicked you on that site. The foot may become floppy and weak after the rupture.

The Thompson test is a clinical evaluation test that may be used to assess the integrity of the Achilles tendon. Slight plantar flexion is a normal response to this examination when there is no presence of a rupture. However, if the Achilles tendon is ruptured, there is no plantar flexion or movement of the ankle in response to squeezing of the calf muscles. X-rays, CT scan, or MRI can be performed to assess the exact site of the injury.

There are three ways to perform an Achilles tendon repair surgery.

1. Open Repair: This type of Achilles tendon repair surgery starts with an incision made on the back of the lower leg starting just above the heel bone. After the surgeon finds the two ends of the ruptured tendon, these ends are sewn together with sutures. The incision is then closed. Occasionally some tissue will be used from the gastrocnemius. This tissue will be folded over and stitched on top of the tendon to make it stronger. Sometimes a graft tissue from a donor is used instead.
2. Minimally Invasive Suture Technique: Another repair method makes a small incision on the back of the lower leg at the site of the rupture. A series of needles with sutures attached is passed through the skin and Achilles tendon and then brought out through the small incision. The sutures are then tied together. The best surgical technique for your Achilles tendon rupture will be determined by your orthopedic foot and ankle surgeon.
3. Percutaneous Repair: The surgeon will make smaller surgical cuts. Three to six cuts may be made, but it depends on the surgeon. The stitches will pass through each hole and end of the ruptured tendon. The stitches will be pulled together reconnecting the tendon. The incision will be closed with stitches.

An Achilles tendon rupture is a serious injury and requires rehabilitation process of about 6 to 9 months. After either type of the above-mentioned surgeries, you will likely wear a cast, walking boots, or similar device for 6 to 12 weeks.

Broadly, there are four stages of rehabilitation of an Achilles tendon rupture surgery. The goals of stage one are healing the tendon as well as reducing pain, swelling and inflammation, and to protect the repaired tendon.

Stage two involves restoring the tendon to its original flexibility and strength. The goals of stage two is to have no pain and swelling and to start range of motion exercises.
Stage three involves returning to normal activity and training levels. The goals of stage three are to achieve full range of motion at the ankles and to start strengthening exercises. The goals of stage four include regaining strength and power.

Lastly, the operation to repair the Achilles tendon rupture can be very successful although does require a player to be out of action for between 7-9 months.