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The Achilles tendon is the largest and strongest tendon in the body, connecting the calf muscles to the heel bone. Despite its strength, it is also vulnerable to injury, particularly in athletes and individuals who engage in high-impact activities. Achilles tendon tears can be debilitating, affecting mobility and quality of life. Understanding when to consider surgery after such an injury is essential for achieving the best possible outcome.

In this blog, we will explore the causes, symptoms, treatment options, and when surgery may be necessary for Achilles tendon tears.

Achilles tendon surgery by Dr. Victor Prisk Monroeville PA

Understanding the Achilles Tendon

The Achilles tendon plays a critical role in walking, running, and jumping, as it helps lift the heel off the ground during movement. Tears of the Achilles tendon typically occur during sudden and forceful activities that put stress on the tendon, such as sprinting, jumping, or pivoting.

Common Causes of Achilles Tendon Tears

Achilles tendon tears are usually the result of acute injury or degeneration over time. The following are common causes:

  • Sudden Stress or Trauma: A rapid increase in activity, such as starting an intense running program or making a quick movement, can lead to a tear.
  • Overuse: Repetitive stress from activities like running or jumping without sufficient recovery time can weaken the tendon.
  • Age and Wear-and-Tear: As we age, tendons lose their elasticity and become more prone to injury. Individuals over 30 are at higher risk, especially those who are less active.
  • Certain Medical Conditions: Conditions like tendonitis or arthritis can weaken the tendon, making it more prone to rupture.
  • Improper Footwear or Training: Wearing unsupportive shoes or training on hard surfaces without adequate support can increase the risk of injury.

Signs and Symptoms of Achilles Tendon Tears

Achilles tendon tears are usually sudden and painful. The symptoms can vary depending on whether the tear is partial or complete. Key signs include:

  • A Sudden “Pop”: Many individuals describe hearing or feeling a “pop” at the back of the ankle during the moment of injury.
  • Sharp Pain: Immediately after the injury, there is usually sharp pain in the lower leg near the heel.
  • Swelling and Bruising: Swelling around the ankle and calf, as well as bruising, is common following a tear.
  • Difficulty Walking: Most people with Achilles tears have trouble bearing weight on the affected leg and may limp or be unable to walk.
  • Weakness or Inability to Push Off: Since the Achilles tendon is responsible for lifting the heel, individuals may be unable to push off the ground with the affected foot.

Diagnosis of Achilles Tendon Tears

If you suspect an Achilles tendon tear, it is crucial to seek medical attention promptly. A healthcare provider will perform a physical exam and may use imaging tests to confirm the diagnosis. Common diagnostic methods include:

  • Thompson Test: During this test, the physician will squeeze the calf muscle. If the foot does not move, it suggests a complete Achilles tendon rupture.
  • Ultrasound or MRI: Imaging techniques like ultrasound or MRI are often used to confirm the extent of the tear and guide treatment decisions.

Treatment Options for Achilles Tendon Tears

Treatment for an Achilles tendon tear depends on the severity of the injury and the individual’s activity level. Non-surgical options may be effective in some cases, while surgery may be necessary for others. Let’s explore the treatment options:

Non-Surgical Treatment

Non-surgical treatment may be recommended for individuals with partial tears, those with a lower activity level, or for patients who want to avoid surgery. Non-surgical treatment involves immobilization and rehabilitation and is generally less invasive. Treatment methods include:

  • Immobilization: The foot and ankle are typically placed in a cast, boot, or brace that keeps the foot in a slightly pointed position, allowing the tendon to heal. This position takes pressure off the tendon and encourages healing.
  • Physical Therapy: After the initial healing period, physical therapy is essential to strengthen the tendon, improve flexibility, and restore range of motion. A structured rehabilitation program can help prevent future injuries.
  • Gradual Weight Bearing: As the tendon heals, patients gradually begin weight-bearing activities under the guidance of a physical therapist. This progression is key to ensuring proper healing and return to function. 

Surgical Treatment

For active individuals, athletes, or those with complete Achilles tendon ruptures, surgery is often the recommended treatment. Surgical repair is typically more effective in restoring the tendon’s strength and reducing the risk of re-rupture. Here are the key aspects of Achilles tendon surgery:

  • Tendon Repair: The surgeon makes an incision in the back of the ankle and stitches the torn ends of the tendon back together. In some cases, tissue grafts may be used to reinforce the repair, especially in patients with degenerative tendon tissue.
  • Minimally Invasive Techniques: Advances in surgical techniques now allow for minimally invasive procedures, which use smaller incisions and specialized tools to reduce scarring and speed up recovery time. Minimally invasive techniques also reduce the risk of complications like infection.
  • Rehabilitation After Surgery: Recovery from Achilles tendon surgery requires immobilization for a few weeks, followed by a structured rehabilitation program. Physical therapy is critical in rebuilding strength and mobility in the tendon.

When to Consider Surgery

The decision to pursue surgery for an Achilles tendon tear depends on several factors, including the patient’s age, activity level, the severity of the tear, and personal goals. Here are some situations where surgery is often recommended:

  • Complete Ruptures: Surgery is the most common treatment for complete Achilles tendon ruptures, especially in active individuals who want to regain full function.
  • High-Performance Athletes: Athletes and individuals with physically demanding jobs often benefit from surgical repair, as it typically leads to a quicker and more robust recovery.
  • Recurrent Tendon Tears: If the tendon has torn more than once or there is significant tendon degeneration, surgery may be necessary to prevent further injury.
  • Failure of Non-Surgical Treatment: If non-surgical treatments fail to restore function or the patient experiences re-rupture, surgery may be the best option.

Risks and Benefits of Surgery

Like all surgical procedures, Achilles tendon surgery carries risks and benefits. It’s essential to understand both before making a decision.

Benefits of Surgery:

  • Faster Recovery: Surgical repair often leads to a faster recovery and return to pre-injury activity levels.
  • Lower Re-Rupture Rate: The re-rupture rate is lower for patients who undergo surgery compared to those who choose non-surgical treatments.
  • Strength Restoration: Surgery helps restore the strength and function of the Achilles tendon more effectively than non-surgical methods.

Risks of Surgery:

  • Infection: As with any surgery, there is a risk of infection at the incision site.
  • Nerve Damage: Some patients may experience nerve damage or numbness near the incision.
  • Scarring: While minimally invasive techniques reduce scarring, traditional open surgery may leave a more prominent scar.
  • Blood Clots: Patients are at risk for blood clots after surgery, so it’s important to follow your surgeon’s recommendations for post-operative care.

Recovery and Rehabilitation

Recovery from an Achilles tendon tear, whether treated surgically or non-surgically, requires patience and dedication to rehabilitation. Here’s what to expect during the recovery process:

  • Initial Healing Phase: For both surgical and non-surgical treatments, the initial phase involves immobilization to allow the tendon to heal. This period typically lasts 4-6 weeks.  Weight-bearing at two weeks is encouraged since this helps the tendon heal. 
  • Physical Therapy: Physical therapy is critical to regaining strength, flexibility, and mobility in the ankle. A personalized rehabilitation program will focus on gradual weight-bearing exercises, strengthening the calf muscles, and improving the range of motion.
  • Return to Activity: Most patients can return to normal walking and light activities within 3-4 months, but high-impact activities like running or jumping may take 6-12 months, depending on the severity of the tear and the success of rehabilitation.

Achieve Lasting Recovery with Prisk Orthopaedics!

Achilles tendon tears can be a painful and disruptive injury, but with prompt treatment and proper rehabilitation, most individuals can make a full recovery. Surgery is often the best option for active individuals or those with complete ruptures who want to regain full function. However, non-surgical options may be suitable for partial tears or less active individuals. If you experience symptoms of an Achilles tendon tear, seek professional medical advice to determine the best treatment for your needs.

If you have questions about Achilles tendon surgery or non-surgical treatment options, contact us at Prisk Orthopaedics and Wellness today for a consultation. We are here to help you get back on your feet and on the road to recovery.