Achilles Tendon Rupture/Rehabilitation

Marko Grzan S.P.T.

            The Achilles tendon, or Calcaneal Tendon, is the largest and strongest tendon in the human body.  It serves to connect the muscles of the posterior leg (Gastrocnemius and Soleus) to their insertion on the Calcaneus bone.  These muscles are major components of walking and athletic activity such as sudden powerful movements including running and jumping. 
            The prevalence of Achilles tendon ruptures continues to rise annually with the occurrence rate reaching as high as 55 cases per 100,000 people.  The rise in prevalence can most likely be attributed to an increasing number of older individuals participating in physical and athletic activity.  Factors other than aging that contribute to Achilles tendon rupture include sudden changes or increases in activity type, tightness/weakness in the calf muscles, leg length discrepancies, use of corticosteroids, or the use of Fluoroquinolone antibiotics such as Cipro or Levaquin, which are commonly administered antibiotics.  Achilles Tendon ruptures are most common among men between the ages of 30-40.  Men are 10 times more likely to suffer the injury and is most common in the episodic athlete AKA the “weekend warrior”.
            Acute ruptures are the most common type and occur when the ankle experiences a sudden and strong dorsiflexion moment (toes are pointed down and then suddenly point up as might occur when landing from a jump).  In the United States basketball is the most common sport where the injury occurs, while soccer is the most common sport associated with the injury throughout the rest of the world. 
            There are several ways to test for Achilles tendon rupture.  The Calf Squeeze test, or the Simmonds/Thompson test, is the gold standard.  With the patient laying prone the calf muscle is squeezed.  If the tendon is intact then plantar flexion of the ankle will occur.  If the tendon is ruptured then no movement will occur. 
            Both Surgical and Non-Surgical repairs have been shown to be effective methods of recovery.  Non-Surgical repair involves immediate bracing of the lower leg and often requires that the patient be non-weight bearing for a longer period of time.  Surgery involves an open repair with the tendon being sutured back together.  Surgery is the recommended method of repair for young athletes seeking return to sport.   
            Goals of rehabilitation include protection of the surgical site, return of a normal gait pattern, full range of motion of all ankle movement, reversal of atrophy, and full functional activity.  The standard rehabilitation process is a multi-stage recovery that begins with protection of the wound site and progresses to weight bearing activities, range of motion activities, and strengthening exercises.  While there are timelines attached to each stage of recovery, it can vary greatly from individual to individual.  
      
 Sources:
U., & U. (2015). Rehabilitation Guidelines for Achilles tendon Repair. Retrieved July 25, 2017, from http://www.uwhealth.org/files/uwhealth/docs/sportsmed/SM-41576_AchillesTendonProtocol.pdf
 
Silbernagel, K., Helender, K., & Willy, R. (2016, February). Achilles Tendon Rupture: Is full Recovery Possible?Lecture presented at Combined Section Meeting, Anaheim.
 
Mullaney, M., McHugh, M., Tyler, T., Nicholas, S., & Lee, S. (july 2006). Weakness in end-range plantar flexion after Achilles tendon repair. American Journal of Sports Medicine,34(7), 1120-1125. Retrieved July 25, 2017.
 
Lantto, L., Heikkenin, J., & Flinkilla, T. (september 2016). A Prospective Randomized Trial Comparing Surgical and Nonsurgical Treatments of Acute Achilles Tendon Ruptures. American Journal of Sports Medicine,44(9), 2406-2414. Retrieved July 25, 2017.
 
Ode, G. (2016, February 29). Causes and Risk Factors for Achilles Tendon Damage. Retrieved July 23, 2017, from https://www.sports-health.com/sports-injuries/ankle-and-foot-injuries/causes-and-risk-factors-achilles-tendon-damage