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Achilles tendon rupture

 

A ruptured Achilles tendon can occur in any healthy person during the practice of certain sports (tennis, football) or accidentally.

It is manifested by violent pain in the heel region, followed by difficulty in walking, sometimes with the feeling that the foot is "sinking" into the ground. The practice of sport immediately becomes impossible, and even walking is done with a strong limp.

The diagnosis is made mainly by manual examination: the doctor feels a gap in the Achilles tendon, and the calf muscle (the triceps) no longer works, or almost no longer. It is of course impossible for the patient to stand on tiptoe.

You can see the rupture on ultrasound or magnetic resonance (MRI), but the examination is usually enough to make the diagnosis.

There are two types of treatment: the so-called "conservative" treatment, that is to say without operation, and the operative treatment.

Conservative treatment  consists of an immobilization in plaster for 3-4 months. Its advantages are: the absence of surgical complications. Its disadvantages are: lengthening of the tendon, hence a reduction in strength, and risk of re-rupture.

Surgical treatment  consists of a suture of the tendon, followed by an immobilization in plaster for 2-3 months. Its advantages are: less elongation, less re-rupture. Its disadvantages are: scar problems, postoperative infection.

The new minimally invasive suturing technique combines the advantages of both techniques: there are fewer re-ruptures, and there are fewer postoperative complications.

Through an incision of about 2 to 3 cm, threads are passed through the 2 ends of the tendon, using a small special device.

Still through the minimal incision, the threads are then tied together, thus bringing the two ends of the Achilles tendon closer together and not bringing them into contact, as in figure 3 below.

The incision is then closed, and the leg is immobilized in a velcro splint for 2 months, sometimes 3.

With the surgical treatment, the ankle is mobilized early, which saves time in recovery. Rehabilitation continues according to a progressive scheme over 3 months. 

Sports activities without impact (swimming, cycling) can be resumed 2 to 3 months after the operation, running from 4 months. On the other hand, you have to wait 6 months to resume impact sports: tennis, football, etc.

Even though recovery is relatively quick, it can sometimes take up to a year to regain full calf muscle strength - patience!