Diagnosis and Treatment of and Achilles Tendon Rupture

An Achilles tendon rupture is somewhat of a dramatic injury when it happens and there are plenty of videos of it happening to elite athletes and also to the weekend warrior athlete. The Achilles tendon is the most powerful tendon in the body and is subject to a lot of force as it crosses two joints, the ankle and knee joints. If both these joints are moving in the opposite direction and the calf muscle contracts it is not hard to see how that load on the tendon can lead to a rupture. It is more common after the age of 40 and in sports like basketball and tennis. Surprising for such a dramatic injury, there is often no or little pain involved.

The diagnosis of a rupture is reasonably easy. It is often easy based on the mechanism of the injury and how it occurred. There is often an audible sound and sudden loss of power from the calf muscles. In the worst cases there is a gap that can be felt in the tendon. A test called the Thompson test is often done. This involves the patient laying face down with the foot over the end of the examination table and the examiner squeezes the calf muscles. If the tendon is intact the foot will move. If the tendon is ruptured, then the foot does not move when the calf muscle is squeezed. Another test, called the O’Brien Needle Test involved putting a small needle into the upper part of the tendon and then moving the foot. If the tendon is ruptured the needle will not move. This test is not used much now as most cases of a suspected rupture are assessed and definitively diagnosed with an ultrasound assessment.

Once the diagnosis is established there are two main options for the treatment of an Achilles tendon ruptures. One is surgical and the other is non-surgical. Regardless of that decision, the initial treatment should start promptly with the use of ice to keep the swelling under control and perhaps the use of a walking brace to relieve the pressure on the injury. The choice of the subsequent treatment will depend on the preferences of the treating doctor and the wishes of the patient. All the research evidence does point to there being no differences in outcomes between the surgical versus the non-surgical approach. The surgical approach may get athlete back sooner but carries the increased risk of any surgery. The non-surgery approach involves the use of a walking brace to limit the movement of the foot and ankle joint. Whichever method is used, the rehabilitation is important. An early return to weightbearing is crucial to increase the loads on the tendon. After walking has started, progressive overload exercises are needed to increase the strength of the tendon and the calf muscle. The final stage of the rehabilitation is to plan for a gradual return to sport. If the process is not done properly, there is a high chance that the injury could happen again.

Craig Payne is a University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger and a dad.