The Achilles tendon connects the calf muscle to the heel bone and is the largest tendon in the body. If it gets torn, partially or completely, it is called a rupture. Walking is difficult and the ankle feels weak.
A popping or snapping sound is often heard when the Achilles tendon ruptures. A sharp and stabbing pain, like being kicked, is felt in the lower leg. This may subside to a dull ache but there is liable to be swelling or bruising, and an inability to climb stairs or bear your full weight. A partial rupture is not so severe, and the snapping sound is not heard. An ultrasound or MRI can determine whether your tendon is partially or completely torn.
For the not so physically active, a plaster cast, boot or brace can be worn for up to eight weeks. The patient can get about on crutches. This immobilises the tendon while it heals. However, there is more chance that the tendon will rupture again so this may not be ideal for you if you are very sporty or athletic.
Surgery is a possibility depending on where the tendon is torn. The repair is made by stitching the tendon back together. Mr. Samarji may do this by either a series of small cuts (‘percutaneous’), one short single cut or open surgery, where the entire tendon is reached. After the operation, you would need to wear a cast for up to six weeks.
Not all patients with an Achilles tendon rupture need an operation. There are some advantages to surgery and there are some advantages in non-operative treatment. Generally, more sporty patients with high sporting demands tend to undergo surgery, whereas patients who are a little older or who lead a sedentary lifestyle may well find that non-operative treatment is the more appropriate treatment option for them. At the consultation a full discussion of the pros and cons of each approach is carried out in order that you are able to make the right decision in your circumstances.
The operation is generally performed quite quickly. The operation takes approximately twenty to thirty minutes. The Tendon ends are sutured back together and the skin is closed. The repaired Achilles tendon is protected in a plaster cast or a walker boot for eight to ten weeks. The operation can be performed as a day case, but the nature of the injury is such that it can occur unexpectedly and if surgery is carried out in the evening as part of the urgency operating list, then an overnight stay may be involved.
Surgery for Morton’s neuroma is generally carried out as a day-case procedure. Following surgery, you will be able to walk on the foot. Arrangements are made for an outpatient appointment approximately two weeks following the operation to remove the stitches.
Following surgery to repair a ruptured Achilles tendon, return to work to an office type job can be between two and three weeks. However the ability to drive a car or other methods of transport needs to be taken into account as well as the demands of the job. For patients with a more heavy or manual aspect job amended duties or altered hours may allow an earlier return to work, but for heavy manual work a full return to work could be at approximately three months. Return to full sports (contact sports) would be at approximately six months following surgery.
All patients who undergo surgery for a ruptured Achilles tendon will require physiotherapy to rehabilitate the foot and ankle and leg. The physiotherapy would consist of strengthening exercises and range of movement exercises to restore the function of the limb. Usually, between six and ten sessions of physiotherapy are needed for rehabilitation following surgery for a ruptured Achilles tendon.
All surgery carries risks, and surgery for a ruptured Achilles tendon is no different. The risks include infection, deep vein thrombosis or pulmonary embolus, nerve or vessel injury or complex pain. The risks are low in frequency but need to be taken into account in any decision to undergo surgery. The purpose of the consultation is to evaluate the problem, to give guidance and information and to allow for the right decision to be made. A consideration of the risks and benefits of surgery, along with the other treatment options, needs to be taken into account.