Achilles Rupture – how to get the spring back in your step!

Achilles injuries are very common and can significantly impact those affected. Tears or complete ruptures to the tendon can be very painful, limit the individual’s walking ability, and require extensive rehabilitation. We see quite a few here at the clinic in Barwon Heads, and it impacts on our patients’ being able to enjoy the activities they love – whether walks along the beach in Ocean Grove, a hit of golf in Barwon Heads, even surfing 13th Beach.

Achilles tendon rupture occurs when there is a tear through the full width of the Achilles, which is the tendon that attaches the calf muscles to the heel bone. This injury can affect anyone but is often seen in athletes as they push off to run. If there is a complete rupture of the Achilles tendon rehabilitation time is much longer than partial tears.

The Achilles tendon is the largest and strongest tendon in the body. It consists of fibers that attach the gastrocnemius and soleus muscle (calf muscles) to the calcaneus (heel bone). This tendon has a major role in walking, running, and jumping as it allows for plantarflexion of the foot (point toes down, or lifting onto your tip toes)

Causes and Risk Factors:

• Sports injuries: Achilles ruptures are often caused by sudden activities that involve accelerating, decelerating, or jumping. This is commonly seen in sports such as basketball, tennis, soccer, and football.
• Overuse/degeneration: Overuse and degenerative changes to a tendon can increase the risk of an Achilles rupture, even in lower-impact activities.
• Medical conditions: Several conditions such as diabetes, gout, and rheumatoid arthritis can weaken tendons and therefore increase the risk of rupture.
• Medications: Some medications, such as fluoroquinolone antibiotics have been linked to increased risk of rupture.

Diagnosis of Achilles Rupture:

Like all conditions, accurate diagnosis is important to determine the best line of treatment for Achilles ruptures. Subjective and objective examinations are used, alongside medical imaging to gather a diagnosis.

Typically, patients describe a sharp pain that is felt at the moment of rupture in the Achilles, during activities involving pushing off such as sprinting, running, and jumping. This is accompanied by a popping sound. On assessment a divet can be felt where the rupture has occurred, swelling may be present, gait will be impaired, decreased plantar flexion and increased ankle dorsiflexion will be apparent. There will also be a positive Thompson test. Imaging will be performed to determine the extent of the injury, whether it is a full or partial rupture, and how far the fibers have retracted. This is seen in ultrasounds and MRIs.

Treatment:

There are two major treatment options for Achilles ruptures, conservative or surgical management. Both management options require a period of immobilization for healing of the tendon followed by rehabilitation and strengthening of the tendon. Surgical management involves the tendon being sutured back together and left to heal with the foot in a cast or moon boot.

After the period of immobilization of the Achilles is completed, rehabilitation needs to begin to restore function, strength, and mobility to the area. Rehabilitation varies depending on the presentation, however follows these general guidelines.

Phase 1: Early Rehabilitation Weeks 1-6 post immobilisation.

• Certain motions will still be avoided as the tendon is still healing i.e. dorsiflexion.
• Swelling management
• Isometric strengthening i.e. calf raise holds.

Phase 2: Intermediate Rehabilitation Weeks 7-12

• Continued improvement of ankle range of motion
• Gait re-education
• Balance and proprioception exercises
• Progression of strengthening exercises i.e. calf raises

Phase 3: Advanced Rehabilitation Weeks 13-24

• Continual progression of strengthening exercises.
• Eccentric calf exercises
• Plyometric exercises
• Return to running
• Sport-specific skills

Achilles tendon rupture rehabilitation is a long progress regardless of surgical or conservative management. Evidence-based rehabilitation strategies, including early mobilization, progressive strengthening, and sport-specific training, play a vital role in restoring function and preventing re-injury.

See our experienced team at 13th Beach Health Services to ensure you get back to the things you love as quickly and as safely as you can.

 

ALL SERVICES