Post on 17-Mar-2019
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AchillestendonruptureAcuteRupture:AcommonscenarioforAchillesruptureoccursinthemiddleagemalewhoundertakesexplosiveactivitysuchasagameofsquash.Bythisagethetendonoftenhasundergonesomedegenerativechangeandmayfailtosustainasuddenstrongresistedmusclecontraction.Thisinjuryhowever,canoccurinanyone.Thefeelingisofbeinghitinthebackofthecalfbyacricketbat.
WhendiagnosedearlyamidsubstanceAchillesrupturecanbetreatedwithoutanoperation.Ideally,ifthetwoendsoftherupturedtendon
canbebroughtintocontactbyplacingtheankleinplantarflexion(pointingthetoe)thenitshouldheal.Theinjurycanalsooccurlowerdownattheinsertionintothecalcaneus(heelbone)orhigheratthemusculotendinousjunctioninwhichcasetheimplicationsmightbedifferentandwillbediscussedatyourconsult.ThesurgicaloptionistohaveanAchillesrepair.Itreducesslightlytheriskofre-ruptureinthefutureandgivesaslightedgeinmaximumsportsperformance.Thisoptioninvolvestheriskofsurgerysuchasinfection,woundbreakdownandnerveinjury.Thesurgerytakesapproximately30minutesandcanbedonethroughanapproximately5cmincision,sometimessmaller.Anacceleratedrehabilitationprogramisusuallyrecommendedregardlessofthechoicebetweensurgeryvsnosurgeryandmustbecloselyadheredtoandbesupervisedbyaphysiotherapist.Aplantarflexioncast(withthetoepointed)isusedinitiallybeforea2weekwoundassessmentandtransitioningtoabootwithaheelraise.ThePhysiotherapistcanthensuperviseyourrehabandyoucanexpecttostartsportspecifictrainingat3monthsbutitisgenerallyrecommendedtotake12monthsofffromseriousrunningandexplosive“pushoff”typesports.ChronicAchillestendonrupture.TherearesituationswhereanAchillesrupturemaynotbediagnosedandtreatedinthefirstfewweeks.Atthisstagethegapbetweentheendsofthetendoncannotbeclosedwithasimplerepair.Thismayinvolveareconstructiveprocedurewhereextralengthtobridgethegapisgainedfromfurtherupthecalf.ThisinvolvesalargerincisionandbecomesasimilarscenariotothatseeninNonInsertionaltendinopathywhichisexplainedearlierinthisinformationsheet.