Achilles tendon ruptures are seen in both athletic and sedentary patients. the Achilles tendon connects the gastrocnemius and soleus muscles to the heel. ruptures usually occur when there is an acute pushoff or plantar flexion force against a solid object such as the ground. There is usually no warning or prodrome. The patients often state that it feels as if someone hit them with a baseball bat just above the ankle.
Typically, the rupture happens 2 inches or so above the heel bone, In area of poor blood vessel supply. the patient is unable to walk as they cannot push off strongly with the foot and cannot rise on her toes. Often the injury is mistaken for an ankle sprain and can occasionally be neglected for prolonged periods time.
The treatment options include casting and surgery. casting involves a short-leg cast with the toes pointed downwards and crutches for some 4-6 weeks followed by a careful program of rehabilitation. Nonoperative treatment can be successful in most cases. The advantage of nonoperative treatment is that surgery with the risk of anesthetic and infection can be avoided. The risk of this however is a markedly increased rerupture rate and difficulty obtaining the correct tendon lengths. this is not a problem in a sedentary individual, but most athletic patient’s choose an operative intervention.
the next article will discuss options of operative treatment.
