Is surgery the best treatment for an Achilles tendon rupture or will it heal on its own with time?
Have you ever had an Achilles tendon rupture? Are you sure? How about a sprained ankle? Tendons connect muscles to bones and there are thousands of them in the human body. The Achilles tendon is the largest and the strongest: it is also the tendon that is most frequently ruptured. Despite that, many people mistake the sudden pain they feel in the area of their lower leg for a sprained ankle.
Misdiagnosing an Achilles tendon rupture can be a serious error. Delaying treatment can have long-term consequences. The tendon may not heal properly and result in weak plantar flexion. This may leave the individual with a limp or make it difficult to run or climb stairs. Eventually, this is likely to create compensation issues in the foot, ankle, and knee. Treatment at that point may be more complex and recovery may take more time.
What Is an Achilles Tendon Rupture?
The Achilles tendon is responsible for connecting the calf muscles to the heel bone. This makes it extremely important as it is involved every time we stand and take a step. Despite being designed to bear excessive forces and especially as we move into middle age, the Achilles tendon becomes more vulnerable to injury from sudden and forceful movements. Although we often experience this as one of those “out of the blue” injuries, there is often evidence of overuse wear and tear on the tendon that is a contributing factor.
While some injuries to the Achilles tendon can take place without producing any symptoms, what typically happens is a sudden and significant stab of pain in the back of the leg. This is often accompanied by a snap that is loud enough to be heard. People usually describe this as feeling like they have been struck directly in their calf by something or someone.
What we call an Achilles tendon rupture is a tear in the tendon. This may or may not mean that the tendon has been totally severed. Pain is usually immediate and there will be a sudden loss of strength and mobility in the ankle.
Treating Achilles Tendon Rupture
All injuries are different and that applies to those of the Achilles tendon. Your orthopedic specialist will base treatment recommendations on the extent of the injury and the general health and lifestyle of the patient. Considerations will likely not be the same for a retiree whose idea of exercise is an occasional stroll around the neighborhood as those for a professional athlete.
Nonsurgical options are available and those who are older and less active can opt for that route. These typically include:
- Keeping the ankle immobile and using a special boot or cast to fix the ankle in a downward flexed position
- Using crutches when walking to keep pressure off of the tendon
For athletes who desire to return to their sport, surgery is the way to regain full function and mobility. This is typically done by approaching the damaged tendon through an incision in the back of the leg and suturing it back together.
Physical therapy will be necessary with either approach and most people should be back to their normal level of activity in four to six months.
If you have questions about an Achilles tendon rupture or about any other foot or ankle concerns, Dr. Christopher Hubbard is a board-certified Orthopedic Surgeon with Ortho-Care Wayne in Passiac County New Jersey and is the former Chief of the Foot and Ankle Service at Mount Sinai Beth Israel in NYC.
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