The Achilles tendon is the most frequently injured tendon around the foot and ankle. With the demographics of an aging population, increasingly aware of the importance of physical exercise and maintaining overall health, both acute ruptures of the tendon and chronic pain from the intact tendon are being seen more frequently. Rupture of the Achilles tendon however is by no means limited to those past the peak of physical fitness or unaccustomed to exercise and it is very much an affliction of the young, active sporting population also.
The history of Achilles rupture is usually classically described as a feeling of being kicked to the Achilles area and sometimes even a very audible “crack” or “snap” is heard. There is an immediate inability to continue with the activity and well-localized pain. In the vast majority of cases bruising behind and to the sides of the ankle and swelling occurs rapidly. You should seek medical advice immediately.
Usually two weeks after a complete rupture there is usually very little pain anymore. At this stage it’s more common to notice a weakness of gait, possibly a feeling of instability and also likely a limp. It will also not be possible to raise yourself onto tip toes on the injured ankle.
If you think you may have torn your Achilles tendon, it is better to get it checked by an orthopaedic surgeon as soon as possible. Early diagnosis with the help of clinical examination and confirmed by a scan can make a difference in it being more treatable, leading to better long-term outcome.
Without treatment, the tendon edges remain apart and heal incorrectly with excessive scar tissue. This causes weakness of the calf muscles leading to difficulty in push-off activities like running or even brisk walking.
Surgical repair: Young, active, fit individuals are advised to undergo repair of their ruptured tendon. Surgical repair has lower risk of rupture and advantage of earlier return to normal activities, including sports. In surgery the ends of torn tendon are approximated and stitched together using minimally invasive techniques, which cause minimal damage to surrounding tissues, thus bringing better outcomes. A boot or a brace is given till it heals. Non-surgical treatment: The leg is immobilized in a plaster cast to approximate the torn end as close as possible. This treatment may be prolonged and associated with weakness of calf muscles and an increase risk of re-rupture compared to surgical treatment.
If the tendon is treated promptly in the most appropriate way, most individuals can return to jogging after 12 weeks and jumping sports in 6-9 months. Office work (sitting on a desk) can be resumed within a week of wound healing. If your job involves heavy labour, it may take 3-4 months to be comfortable at work.