The Achilles tendon is the largest tendon in the body and runs behind the ankle, connecting the calf muscle to the heel. This tendon bears a significant amount of force during activities such as running or jumping, and injuries are very common. The tendon is also very close to the skin, which has important implications during treatment and rehabilitation.
Rupture of the Achilles tendon is common. This injury occurs most commonly in middle-age men during athletic activities, but can affect both men and women of any age. Most commonly patients report a “pop” in the back of their ankle with the sensation of being kicked or struck by an object. Immediately after the injury there may be moderate pain, but in some cases pain is not severe. You may have difficulty flexing your ankle to point your toes and walking can be challenging. After a day or two bruising will develop at the site.
Achilles tendon ruptures can be treated with and without surgery. There is currently a debate regarding which treatment option is best, and both have risks and benefits. You should discuss the differences between surgical and non-surgical treatment with your surgeon. If treated without surgery, patients will typically be instructed to use a walking boot or a cast for 6-8 weeks. The position of the foot will change every couple weeks to allow for more and more ankle dorsiflexion (toes toward the head). If surgical treatment is selected, your surgeon will sew the tendon back together and may use an additional tendon for strength in the repair.
Rehabilitation and physical therapy play a critical part in your recovery for either surgical or non-surgical treatment. The importance of physical therapy after an Achilles tendon rupture cannot be over emphasized to prevent ankle stiffness. However, it is critical that you follow your surgeons instructions for motion and weight bearing restrictions. In the early recovery period, physical therapy exercises are prescribed to decrease pain and swelling and to maintain ankle range of motion. In addition, therapy is important for proprioception, which is the body’s ability to sense its location in space, which can help prevent future injuries. As you progress with your therapy, strengthening and special training exercises can help your reduce your risk for repeating the same injury. Exercises should be performed in a supervised setting, as well as at home on your own time. Your commitment to rehabilitation is key to a successful outcome.