Physical Therapy For Achilles Tendon Rupture Surgery Technique

posted on 30 Apr 2015 00:14 by juan8benjamin1
Overview
Achilles Tendon The Achilles tendon connects the muscles in the back of your calf to your heel bone. There are two basic variations of Achilles injuries. Achilles tendonitis, and a complete tear. It?s important to know whether the Achilles is torn or not, because the treatment is very different, a torn Achilles may require surgery. Achilles tendonitis probably means rehab and rest. While tendonitis is a gradual onset of pain that tends to get worse with more activity, an Achilles tear is a sudden injury, and it feels as if you were hit or kicked in the back of the ankle. A tear usually affects your ability to walk properly. Because an Achilles tendon rupture can impair your ability to walk, it?s common to seek immediate treatment. You may also need to consult with doctors specializing in sports medicine or orthopaedic surgery.

Causes
The tendon is susceptible to injury and can rupture during vigorous activities such as running and jumping. Rupture can also occur as a result of gradual wear. After becoming chronically weakened, it can rupture during non-stress activities like walking.

Symptoms
The pain from an Achilles tendon rupture is usually felt in the back of the lower leg, in the area 2 to 6 cm. above the Achilles tendon's attachment to the calcaneus. Individuals with an Achilles tendon rupture often describe a "pop" or similar feeling at the time of the injury. A "hole" or defect in the Achilles tendon can usually be felt under the skin in this area. A limp and inability to rise up on the toes of the affected foot are usually present. If the affected foot does not plantar flex when the calf muscles are squeezed an Achilles tendon rupture is very likely.

Diagnosis
Diagnosis of Achilles tendon rupture is not difficult. Usually, the diagnosis is obvious after examination of the ankle and performing some easy foot maneuvers (such as attempting to stand on the toes). When an Achilles tendon rupture occurs, there is often clinical confirmation of tenderness and bruising around the heel. A gap is felt when the finger is passed over the heel area, where the rupture has developed. All individuals with a full-blown rupture of the tendon are unable to stand on their toes. There is no blood work required in making a diagnosis of Achilles tendon rupture. The following are three common radiological tests to make a diagnosis of Achilles tendon rupture. Plain X-rays of the foot may reveal swelling of the soft tissues around the ankle, other bone injury, or tendon calcification. Ultrasound is the next most commonly ordered test to document the injury and size of the tear. For a partial tear of the Achilles tendon, the diagnosis is not always obvious on a physical exam and hence an ultrasound is ordered. This painless procedure can make a diagnosis of partial/full Achilles tendon rupture rapidly. Ultrasound is a relatively inexpensive, fast, and reliable test. MRI is often ordered when diagnosis of tendon rupture is not obvious on ultrasound or a complex injury is suspected. MRI is an excellent imaging test to assess for presence of any soft-tissue trauma or fluid collection. More importantly, MRI can help detect presence of tendon thickening, bursitis, and partial tendon rupture. However, MRI is expensive and is not useful if there is any bone damage.

Non Surgical Treatment
You may need to wear a plaster cast, brace or boot on your lower leg for six to eight weeks to help the tendon heal. During this time, your doctor will change the cast a number of times to make sure your tendon heals in the right way. If your tendon is partially ruptured, your doctor will probably advise you to have this treatment instead of surgery. It?s also suitable for people who aren't very physically active. However, there is a greater risk that your tendon will rupture again, compared with surgery. Your doctor will advise you which treatment is best for you. Achilles Tendon

Surgical Treatment
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.