The Achilles tendon, the longest tendon in the body, is located behind the ankle. It connects the calf muscles to the back of the heel bone. The Achilles tendon is important for push-off strength when walking, running, and jumping.
Achilles tendon ruptures are often sustained by “weekend warriors”, that is, people who live a sedentary lifestyle during the week, but then partake in recreational activities on the weekend. Other risk factors for rupture are local corticosteroid injection, chronic steroid use, quinolone antibiotics, gout, hyperthyroidism, renal insufficiency, and arteriosclerosis.
There are several theories for the cause of Achilles tendon ruptures. These include degeneration of the tendon, decreased blood supply to the tendon, and mechanical overload. When rupture occurs, many people describe hearing and feeling a pop in the back of their leg as they accelerate. The diagnosis of a ruptured Achilles tendon is made by physical examination. There usually is no need for imaging studies to confirm the diagnosis.
Treatment includes non-surgical methods and surgical repair. Nonoperative treatment is a reasonable option for people who are not medically stable enough for surgery, as well as for more sedentary patients. This treatment option, however, has a higher risk for re-rupture versus operative management. Non-operative treatment seeks to avoid risks associated with surgery, such as impaired wound healing, infection, and/or nerve damage. With non-operative treatment, the patient is placed in a splint with the foot in maximum plantarflexion, to bring the two ends of the tendon in close proximity. After a few weeks, the splint is removed and the patient is transitioned to a boot with heel lifts, to keep the foot plantarflexed.
Surgical repair is recommended for highly active patients, as well as those who re-rupture their Achilles tendon. The surgical procedure results at each end of the tendon being stitched back in place. Surgical risk is wound complication at the incision site (delayed healing or infection due to the poor blood supply to the region). For this reason, Dr. Moon repairs the tendon using a minimally invasive approach, with a final incision length that is usually under 2 cm in length.
With Achilles ruptures that are over 3 weeks old, or with re-ruptures, Dr. Moon usually transfers the adjacent flexor hallucis longus tendon to the heel bone, to give the repaired Achilles more power and strength. This approach, however, is performed with a larger incision. In all cases, patients are given a strict post-operative physical therapy protocol. If patients do not follow the protocol and are too aggressive with activity, strengthening, and/or stretching during the first 6 months after surgery, there is an appreciable risk of surgical failure.