achilles tendon rupture in Tunisia

Tendon Anatomy

The Achilles tendon forms from two muscles at the back of the calf, the gastrocnemius and soleus, about 15 cm to 6 inches above the ankle joint and spirals as it crosses the ankle joint to attach to the heel bone (calcaneus). A sheath surrounds the tendon, allowing it to glide easily when the ankle moves through its range of motion. Since the calf muscles originate above the knee and the Achilles attaches below the ankle, the function of the muscle-tendon unit is essential for walking and running. When the calf muscles contract, the ankle points the foot downward and the foot turns inward and upward). (See image 1.) The tendon must be strong. Running and climbing stairs generates a force within the tendon equal to 10 times body weight.

Non-Surgical Treatment

The non-surgical method may be recommended for older, less active patients with higher risk of surgery and anesthesia. The ability to heal wounds is also an important consideration and may include those with poor blood supply to their feet. This includes patients with peripheral artery disease and diabetes.
Non-surgical management involves applying a short leg cast to the injured leg, with the foot in a slightly downward flexed position. Keeping the ankle in this position helps bring the ends of the ruptured tendons closer together to allow them to heal. The leg is placed in a cast for six to 10 weeks and no ankle movement is allowed. Walking is allowed on the cast after a period of four to six weeks. When the cast is removed, a small heel lift is inserted into the shoe to reduce tension on the Achilles tendon for an additional two to four weeks. After that, physical therapy is recommended.
The disadvantages of the non-surgical approach include an increased risk of re-rupture (up to 40%), prolonged immobilization in a cast, and increased technical difficulty if subsequent surgery was needed.
Benefits include no need for anesthesia or hospitalization, decreased risk of skin breakdown, and decreased risk of nerve injury.

Surgical Treatment

Surgery is the recommended treatment for young, healthy and active people. For athletes, surgery is often the first choice of treatment. The Achilles tendon can be surgically repaired by percutaneous or open technique. With the open technique, a doctor makes an incision to allow better visualization and approximation of the tendon. With the percutaneous technique, the surgeon makes several small skin incisions to repair the tendon. Regardless of the type of treatment, a healthcare professional will apply a short leg cast or postoperative boot to the operated ankle after the procedure is completed. Each approach has its benefits and risks and the choice of surgery type is individualized for each specific patient.

What are the possible complications of an Achilles tendon rupture?

Complications of Achilles tendon rupture include tendon scarring and decreased range of motion, as well as muscle weakness. Re-rupture of the tendon is a major concern and can occur in up to 5% of patients who have undergone surgical repair, and in some studies up to 40% in conservatively treated patients. Other surgery-related complications include skin sloughing, wound infection, nerve damage and scarring.

What is the recovery time for an Achilles tendon rupture?

After surgery, the patient is kept in a cast for four to six weeks, followed by physical therapy and assisted range of motion exercises. A heel lift will be placed in the shoe to prevent overstretching of the tendon. Return to normal functioning is expected in four to six months.
With conservative treatment, serial casting occurs. Casts are changed every few weeks, with the foot placed in less plantar flexion each time. This will occur for six to 12 weeks. Once casting is complete and the tendon has healed, physical therapy will continue to restore range of motion and strength. A shoe heel lift will be considered.