The Achilles tendon is found in the back of the leg above the heel, and is the largest tendon in the body. It connects the calf muscles to the heel bone and is used when walking, running, and jumping.
A rupture of the tendon is a tearing and separation of the tendon fibers. When a rupture of the tendon occurs, the tendon can no longer perform its normal function. A common issue related to a tear is the inability to point your toe.
The tendon is susceptible to injury and can rupture during vigorous activities such as running and jumping. Rupture can also occur as a result of gradual wear. After becoming chronically weakened, it can rupture during non-stress activities like walking.
A consultation and physical exam with a qualified musculoskeletal expert is the first step. X-ray or MRI scanning may be required for a diagnosis. Once a rupture is diagnosed it should be treated to prevent loss of strength and inadequate healing.
Two treatment options are casting or surgery. If an Achilles tendon rupture is untreated then it may not heal properly and could lead to loss of strength. Decisions about treatment options should be made on an individual basis.
Non-surgical management traditionally is selected for minor ruptures, less active patients, and those with medical conditions that prevent them from undergoing surgery. The goal of casting is to allow the tendon to slowly heal over time. The foot and ankle are positioned to bring the torn ends of the tendon close together. Casting or bracing for up to 12 weeks or more may be necessary. This method can be effective and avoids some risks, such as infection, associated with surgery. However, the likelihood of re-rupture may be higher with a non-surgical approach and recovery can take longer.
Surgery could allow for a quicker healing time. The procedure generally involves making an incision in the back of your lower leg and stitching the torn tendon together. Depending on the condition of the tissue, the repair may be reinforced with other tendons. As with any surgery, the main complication is the risk for infection: however, this risk is reduced by using smaller incisions.
Whether surgical or non-surgical, the recovery period requires rehabilitation to restore tendon strength and foot and ankle motion. During the initial healing phase, you will be unable to bear weight on the foot for 12 or more weeks, and will be required to use crutches or a walker. Physical therapy will be important in helping you regain your strength and motion, begin walking again without assistive devices, and eventually return to your regular function.