The Achilles tendon is the largest tendon in the human body. It is both powerful and flexible, allowing us to run and jump. The tendon acts like a spring and stores and uses energy to spring us forwards or upwards. Unfortunately we can use this great ability to its maximum and damage can occur. Achilles tendon ruptures are an incredibly common injury. Sometimes the injury can be caused whilst playing sport; a quick push off on the squash court or taking a particularly tricky shot in tennis, and sometimes it can occur due to an accident or overstrain; for example missing a step and landing oddly on the next. Patients often describe this as a feeling of being ‘shot in the back of the leg’ and this can occasionally be audible to others.
The Treatment Dilemma
In current practice this presents a dilemma to medical practitioners. How to best manage this injury? There are two main options at present. One is to go under the knife and have the two ends of the tendon surgically reattached back together, the other is to have the tear conservatively managed with a period of immobilisation and then intensive physiotherapy input and careful rehabilitation. When considering the risks, we must consider that surgery may lead to infection, deep vein thrombosis and pulmonary embolisms. The only risks for conservatively managed repairs is the comfort of the boot needed for immobilisation but both surgical and conservative management share a risk of failure and previously this risk has been higher in conservatively managed repairs. Failure of the management option and a re-rupture can mean starting all over again, or even permanent loss of function. Recently there has been some interesting and hopeful results from Morriston Hospital in Swansea, Wales. They have found that their re-rupture rate after conservative management is only 1.1%. That is significantly less than the 20% average for conservatively managed ruptures and 5% for surgically managed ruptures.
Non-Surgical Treatment is a Viable Option
Having analysed their management strategies it appears from Morriston Hospital’s work that there is a viable option to consider non-surgical conservative management of your Achilles tendon rupture. Managing your injury conservatively appears to cut your risk of infection whilst keeping a similar recovery timescale back to sport and activity if you were treated surgically. Conservative treatment requires careful management by both an orthopaedic foot and ankle specialist alongside excellent rehabilitation. You would also need to be in touch with your physiotherapist regularly to ensure you are reaching the milestones required for your stage of recovery. You should also be guided on how to improve your balance and proprioception as well as maintaining good movement habits and walking quality. This can be one of the hardest parts of recovery of a lower limb injury and careful instruction on how to regain good walking technique is invaluable.
If you have ruptured your Achilles tendon, talk carefully to your consultant about your options and ensure you discuss conservative options as well as surgical. There is a place for surgical repair in a demographic of young athletes, but in both cases remember that professional guided rehabilitation is key to a successful recovery.