Achilles tendon injuries
The Achilles tendon can rupture (snap) if a sudden force is applied to it. The commonest age group affected is 30-40 year olds. This is due to the fact that as we age the quality of our tissues weaken and the ability to self repair slows. The majority of injuries are sporting but missing a step or falls can produce these injuries.
The most important factor is to recognise the diagnosis. Later presentation to an orthopaedic surgeon can result in more difficult treatment and poorer outcomes.
The majority of patients are now managed in a functional boot with a series or removable wedges or a boot with an external hinge. This type of treatment has been shown to be as good as surgery in most patients without the risks of surgery.
Immediate weight bearing is recognised in numerous studies to be both safe and to encourage improved tendon healing. After 8 weeks of sequential removal of wedges the ankle is at a right ankle to the leg. The boot is then removed and physiotherapy commenced. Return to sports is not advised for at least 6 months. The tendon will remain thickened compared to before injury. There is a small risk that the tendon will re-rupture if vigorous exercise is resumed too early.
Benefits of surgery
There are a small number of young, elite sports persons who may benefit from surgery. As these patients return to high frequency and high loading exercises then there is evidence that tendon strength is improved with surgery and the re-rupture rate is lower.
Risks of surgery
The main risks are of poor wound healing and infection. Both are rare but highly problematic sometimes needing more surgery.
Example of an angled boot