The exact number of people who develop Achilles tendon injury is not known, because many people with mild tendonitis or partial tear do not seek medical help. It is believed to be more common in men
but with the recent participation of women in athletics, the incidence of Achilles tendon injury is also increasing in this population. Overall, injury to the Achilles tendon is by far most common in
the athlete/active individual.
Often the individual will feel or hear a pop or a snap when the injury occurs. There is immediate swelling and severe pain in the back of the heel, below the calf where it ruptures. Pain is usually
severe enough that it is difficult or impossible to walk or take a step. The individual will not be able to push off or go on their toes.
Typically patients present with sudden onset of pain and swelling in the achilles region, often accompanied by a audible snap during forceful dorsiflexion of the foot. A classic example is that of an
unfit 'weekend warrior' playing squash. If complete a defect may be felt and the patient will have only minimal plantar flexion against resistance.
The diagnosis of an Achilles tendon rupture can be made easily by an orthopedic surgeon. The defect in the tendon is easy to see and to palpate. No x-ray, MRI or other tests are necessary.
Non Surgical Treatment
There is no definitive protocol for conservative management. Traditionally, conservative treatment involved immobilisation in a cast or boot, with initial non-weight bearing. Recently, good results
have been achieved with functional bracing and early mobilisation, and it is common to be immediately weight-bearing in an orthotic. Conservative management reduces the chance of complications, such
as infection. There is a risk the tendon can heal too long and more slowly.
Surgery may be indicated directly following injury rather than conservative care. Repair of an achilles tendon rupture is greatly varied for each clinical situation. There may be a direct repair of
the ends of the tendon with suture, or possibly a tendon graft used to augment the tendon. Post-operatively, the period of immobilization will depend on the size of the defect that was repaired and
how it was completed. Usually the immobilization is between 6-10 weeks. This repair may allow for a complete return to normal function, but in many instances the healing is complicated with adhesions
and a partial loss of range of motion. There may be a continued soft tissue defect noted and a permanent or prolonged swelling.