Achilles Tendon Ruptures

While it is the strongest tendon in the body, the Achilles tendon is also the one most frequently injured. A rupture, or tear of the Achilles tendon most commonly occurs in a male, 35 to 55 years old, during recreational activity involving rapid stopping and starting (soccer, basketball, football, tennis, etc.). Victims of an Achilles rupture often feel a pop and report a sensation of being kicked or struck in the back of the lower leg. Pain, swelling, and weakness ensue.

An Achilles tendon rupture can almost always be diagnosed by patient history and physical examination alone. If there is a question regarding diagnosis, an ultrasound or MRI can be used as confirmation.

Treatment of Achilles tendon rupture can be conservative or surgical. Conservative managment involves cast or brace protection and early physical therapy. Benefits of conservative managment mostly involve avoidance of potential surgical complications including infection, wound problems, and nerve injury. Conservative management can have its own problems, however, including prolonged recovery, a greater potential for residual weakness, and a higher incidence of re-rupture when compared to surgical controls.

Operative treatment involves a skin incision and repair of the ends of the ruptured tendon using suture. The goal of surgical treatment is to provide a stable repair that will allow early weight bearing and tendon mobilization. In both operative and non-operative cases, early mobilization has been shown to provide superior results.

Complications of achilles surgery mostly revolve around wound complications. The skin covering the achilles tendon is relatively thin and its local blood supply can be tenuous. Wound complications may be mitigated, however, with the use of small incision techniques that minimize soft tissue injury.

On balance, surgical care may result in a quicker recovery and greater patient satisfaction in healthy, vigorously active individuals. In older, more sedentary patients, or those with significant medical problems, conservative mangement may be preferable.