The Achilles Tendon is located at the back of the leg and connects the calf muscle to the calcaneus. It is the thickest, strongest and longest tendon in the human body.
Playing sports is the most common reason why a Tendo Achilles rupture occurs It is most commonly reported in patients aged 30 – 40. Often patients describe hearing a pop, which is followed by sharp pain, tenderness and weakness.
Full strength is rarely fully regained without the aid of surgical intervention after an Achilles rupture. Clinical diagnosis in isolation is common but an ultrasound is a useful supporting diagnostic test.
Conservative treatment is generally not recommended for people who wish to lead an active lifestyle.
The most common treatment is surgical repair. The benefit of surgery is that maximum strength of the tendon is regained. The surgeon must ensure correct tension and length at time of surgery.
The benefit of surgery is that maximum strength of the tendon is regained.
Mr Edwards has an integral role, as he must ensure the correct tension and length of the tendon. After the surgery the patient is placed in a cast for approximately two weeks. At the follow up appointment this cast is generally replaced with a CAM boot. The patient remains non weight bearing for 6-8 weeks post surgery. After this time the patient will weight bear in the CAMboot for 2-3 weeks, then progress into a supportive shoe with a heel raise.
Rehabilitation is vital. Physiotherapy and hydrotherapy should be undertaken to facilitate recovery and explosive sport should be avoided for at least six months.
Insertional Achilles Tendinopathy
Insertional Achilles tendinopathy occurs when there is damage or degeneration in the area where the tendon attaches to the heel bone. Symptoms include tenderness on the lower back of the heel and stiffness. Pain generally tends to be worse after activity. This condition often develops along with retrocalcaneal bursitis.
A Haglunds Deformity a condition caused by a prominent bump on the back of the heel. This can cause abrasion of the Achilles tendon. Pain at the back of the heel is the most common symptom. The heel can become swollen and inflamed and be aggravated by shoes.
Conservative treatment includes changing activity, massage, heel raises, stretching and medication.
There are a number of different surgical procedures to treat this condition. Ultimately the aim of surgery is to debride and decompress the heel to decrease pain an rubbing.
The most effective surgical intervention is a calcaneal osteotomy (removal of bump) to decompress the heel and an Achilles tendon debridement and reattachment to the calcaneus.