Diagnosis
During the physical exam, your doctor will inspect your lower leg for tenderness and swelling. Your doctor might be able to feel a gap in your tendon if it has ruptured completely.
The doctor might ask you to kneel on a chair or lie on your stomach with your feet hanging over the end of the exam table. He or she might then squeeze your calf muscle to see if your foot will automatically flex. If it doesn't, you probably have ruptured your Achilles tendon.
If there's a question about the extent of your Achilles tendon injury — whether it's completely or only partially ruptured — your doctor might order an ultrasound or MRI scan. These painless procedures create images of the tissues of your body.
Treatment
Treatment for a ruptured Achilles tendon often depends on your age, activity level and the severity of your injury. In general, younger and more active people, particularly athletes, tend to choose surgery to repair a completely ruptured Achilles tendon, while older people are more likely to opt for nonsurgical treatment.
Recent studies, however, have shown fairly equal effectiveness of both surgical and nonsurgical management.
Nonsurgical treatment
This approach typically involves:
- Resting the tendon by using crutches
- Applying ice to the area
- Taking over-the-counter pain relievers
- Keeping the ankle from moving for the first few weeks, usually with a walking boot with heel wedges or a cast, with the foot flexed down
Nonoperative treatment avoids the risks associated with surgery, such as infection.
However, a nonsurgical approach might increase your chances of re-rupture and recovery can take longer, although recent studies indicate favorable outcomes in people treated nonsurgically if they start rehabilitation with weight bearing early.
Surgery
The procedure generally involves making an incision in the back of your lower leg and stitching the torn tendon together. Depending on the condition of the torn tissue, the repair might be reinforced with other tendons.
Complications can include infection and nerve damage. Minimally invasive procedures reduce infection rates over those of open procedures.
Rehabilitation
After either treatment, you'll have physical therapy exercises to strengthen your leg muscles and Achilles tendon. Most people return to their former level of activity within four to six months. It's important to continue strength and stability training after that because some problems can persist for up to a year.
A type of rehabilitation known as functional rehabilitation also focuses on coordination of body parts and how you move. The purpose is to return you to your highest level of performance, as an athlete or in your everyday life.
One review study concluded that if you have access to functional rehabilitation, you might do just as well with nonsurgical treatment as with surgery. More study is needed.
Rehabilitation after either surgical or nonsurgical management is also trending toward moving earlier and progressing faster. Studies are ongoing in this area also.
Preparing for your appointment
People with an Achilles tendon rupture commonly seek immediate treatment at a hospital's emergency department. You might also need to consult with doctors specializing in sports medicine or orthopedic surgery.
What you can do
Write a list that includes:
- Detailed descriptions of the symptoms and how and when the injury occurred
- Information about past medical problems
- All the medications and dietary supplements you take, including doses
- Questions to ask the doctor
What to expect from your doctor
The doctor may ask you some of the following questions:
- How did this injury occur?
- Did you feel or hear a popping or snapping sound when it happened?
- Can you stand on tiptoe on that foot?
Aug. 25, 2022