The Achilles tendon is located near your ankle and attaches your heel bone to your calf muscles in order to create the downward strength that your foot requires in order to undertake daily motions, including walking and jumping. Despite being your strongest and largest tendon, it can become damaged when it is overstretched as a result of overuse, activity following periods of atrophy, direct force, or a sudden movement of the ankle beyond its normal boundaries. These actions frequently occur during athletics, but can affect people in any setting and often occur swiftly. You can take steps to minimize the risk of an Achilles tendon injury by avoiding physical activity that is immediately high-intensity or that is not preceded by adequate stretching and warming-up.
An Achilles tendon injury is indicated by significantly impaired walking, shooting pain, a loud popping noise, and a warm feeling near your Achilles tendon area. After such an injury, surgery is often performed in order to reconnect the Achilles tendon, generally through the reattachment of torn areas of the tendon, although other surgical methods are available, including procedures that involve one incision (open surgery) or several smaller ones (percutaneous surgery). Damage to your Achilles tendon can be otherwise addressed through casts or similar devices to immobilize your leg and anti-inflammatory medications, physical therapy, cortisone injections, and rest and ice. However, the desirability of any nonsurgical option varies with each patient’s activity level, age, and injury. The increased chances of further tendon damage and leg weakness that accompany nonsurgical methods, and the fact that the recovery timetables for each are similar to that of surgery, may also make surgery a better option for many patients.
Did You Know? There are over 250,000 serious Achilles tendon sports injuries in the U.S. each year, with more than 60,000 of such injuries requiring surgery, ER or hospital visits, or some form of therapy. Many of these ruptures are longer in duration, with more than 110,000 preventing athletic participation for up to one month, and 60,000 such injuries hindering those activities for more than one month. Due to the prevalence and severity of this type of injury, Achilles tendon ruptures are among the most frequently treated types of injuries by general practitioners and orthopedic surgeons.
There are several types of surgery, which vary based upon the location and severity of the injury. Through débridement and repair, tendons with less than 50% damage can be repaired via stitches or sutures through metal or plastic prosthetics that affix the heel bone to the Achilles tendon. This occurs once the damaged tendon has been removed (as well as the bone spur, if the patient has tendon degeneration known as insertional tendinitis).
After débridement and repair, most patients are allowed to walk in a removable boot or cast within weeks, although this period depends upon the amount of damage to the tendon. In cases where more than 50% of the Achilles tendon is not healthy and requires removal, the remaining portion of the tendon is not strong enough to function alone. To prevent the remaining tendon from rupturing with activity, an Achilles tendon transfer is performed. The tendon that helps the big toe point down is moved to the heel bone to add strength to the damaged tendon. After this procedure, the big toe will still be able to move, and most patients will not notice a change in the way they walk or run. Depending on the extent of damage to the tendon, some patients may not be able to return to competitive sports or running.
Immediately after the procedure, patients are fitted with a cast and must avoid putting any weight on the tendon and must use crutches, a wheelchair or an alternative method for mobility. Over the course of six or more months, patients will transition from the cast to a walking boot, begin putting weight on their repaired Achilles tendon, and undertake regular, intensive physical therapy in order to restore mobility and strength in the tendon. Generally, most patients are able to return to their pre-injury activity level, however each recovery is based upon certain factors, including when the surgery occurs, the patient’s age, the degree of the tendon injury, and more.