An Achilles injury, or Achilles tendonitis, is an injury due to the overuse, sprain, or complete rupture of the Achilles tendon. This tendon attaches muscles at either end of the bone, and injuries to the Achilles tendon can vary in severity from a dull ache to severe pain. They also have a covering or “sheath” that can get irritated, tear or form a “ganglion” (fluid filled sack).
Tendonitis can be a simple overuse syndrome, injury, or secondary problem from other foot and ankle conditions. All tendonitis injuries, especially ones where a tear, rupture or associated fracture is suspected need to be evaluated by a physician with standard X-rays taken or other advanced testing.
Most people with a damaged or injured Achilles tendon report the feeling of having been kicked in the calf. Some state that they heard a loud ‘pop’ when playing sports and felt major pain near the back of the heel. Also common is the inability to bend the foot downward, or movement of the foot downward when squeezing their calf muscle and the inability “push off” the injured leg when walking.
This condition is associated with other foot and ankle conditions such as:
Each patient is different and conservative treatment vs. surgical correction both differ for the particular type of problem, age and lifestyle. The right treatment must also meet the patient’s expectations in regard to resolution of their problem(s) and future functionality.
If conservative treatment fails, the option to not have surgery is as important as the surgery chosen by your surgeon. Of course, surgical training is very important, and continuing medical education on the latest medical advancements is important as well, but it’s the careful planning before and after surgical treatment that produces the best outcome.
Crutches and non-weight bearing on the affected foot or ankle for 1 to 3 weeks is the best care for a severe overuse syndrome or injury like an Achilles injury, but a simple decrease in activities may be enough to relieve symptoms.
Static stretching to the “point of discomfort” and holding those positions for 10 seconds each for 3 sets every day will help speed recovery and recurrence.
Anti-inflammatory medication can help with the chronic pain, but are not much help with the acute pain
Casting or a removable CAM walker is the best “aggressive” conservative care for severe tendonitis or injuries. Temporary arch supports or supportive athletic shoes will support the foot and ankle in a more neutral position. This will put less strain on the injured area and decrease the incidence of re-injury when returning to activities or exercise. Custom molded orthotics are the best solution for immediate and long term treatment.
Examples of physical therapy that can help Achilles injuries include massage, cold therapy, contrast baths, stretching, ultrasound, and electric stimulation.
No surgery is usually required for this condition, but partial tears, “attenuations” or complete ruptures may necessitate surgical reattachment. The procedure is a simple suturing of the tendons ends unless a graft or reattachment to the bone with a “bone anchor” device is needed.
The postoperative period is extended to 6-8 weeks non-weight bearing, with physical therapy thereafter.
Prior to an Achilles surgery it is very important to remain avoid bearing weight and in position the foot in a splint with the foot pointing downward. Other things to consider are shaving and washing the area prior to surgery. It is also critical to remove obstacles at home and make sure the correct post-operative assistive devices are available (crutches, walker, knee scooter, wheelchair) and you have a plan to easily access the bathroom, shower, and prepare food.
Yes, they put you to sleep during Achilles surgery. General anesthesia is the preferred method for Achilles surgery since a thigh tourniquet is used during the surgery and some operating times can be lengthy. A spinal or popliteal block with sedation is possible, but will depend upon the surgeon’s preferences and patient medical history.
The achilles tendon does not require strengthening immediately after surgery and is best to let it heal for 6 to 8 weeks. The calf muscle (Gastrocnemius-Soleus complex) can be strengthened with simple walking, but physical therapy and proper exercises are recommended.
Returning to work after an Achilles tendon surgery depends on the type of work and how much stress is placed on the lower extremity. If a patient can use crutches and assistive devices like a knee scooter or wheelchair, they can go back to work as soon as a week or two. It takes an achilles tendon 6 to 8 weeks to reach a particular ‘tensile strength’ to warrant walking with full weight bearing. Keep in mind—even a sit down job still requires the patient to drive to work, walk around during breaks, and move to the parking lot and bathroom.
If you’re someone who walks more than 10,000 steps, or lifts items, climbs stairs, or exerts more physical activities in your job, then the return to ‘normal’ activities could be 3 to 6 months.
Recovery for an Achilles tendon surgery is a relative term that depends on each patient. Age, genetics, weight, and other medical conditions contribute to the recovery of this surgery as well. Non-weight bearing is between 6 to 8 weeks, and then partial to full weight-bearing can occur after 6-8 weeks, but should include some physical therapy, stretching and early activities in a walking cast or cam walker. Pain, swelling or weakness are indicators to guide the surgeon and patient through the recovery period. As these symptoms lessen with each increase in activity, then more activities like exercise can be introduced.
This patient has previously underwent TWO achilles tendon rupture surgeries that failed at another surgeon’s clinic. He came to our clinic with concerns about an additional surgery and to discuss his options and the risks to repair his achilles tendon.
Contact Moore Foot and Ankle Specialists today to discuss treatment options for chronic ankle instability and start your journey towards healing.
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