Achilles Tendon Rupture - Treatment
How can it be treated?Non-operative treatment: As long as the ends of the torn Achilles tendon can be brought together then they will tend to heal together naturally. Pointing the foot down (plantarflexion) brings the tendon ends together in most acute cases and maintaining this position in a cast followed by a functional brace is then needed. The traditional method of managing these in a cast with absolutely no movement or weight-bearing through the injured leg is no longer used and the results with that type of treatment were often poor. Because of this surgery was recommended more frequently than it is. At The Suffolk Foot & Ankle Clinic we employ the most up to date non-operative treatment algorithms. This means the time in cast is generally limited to only two weeks. This is followed by functional bracing where you walk in only a brace which gently loads the haling tendon and leads to a more robust final repair. Not having an operation means-
- No risks of an operation- anaesthetic, wound healing problems, infection or nerve injury.
- Increased risk of the tendon rupturing again (re-rupture) compared to surgery- with modern functional non-operative algorithms this risk is low.
- Slightly longer period of immobilisation and rehabilitation.
- There may be more long term weakness noted compared to surgical treatment- again with modern functional non-operative algorithms this risk is low.
Operative treatment: This may be advisable in more athletic patients as it can lead to a more rapid recovery. It is also generally required where there are delays in initial treatment or if the tendon ends do not come together by pointing the foot down as this generally stops non-operative from working well. During surgery the tendon ends are brought together and held in place with stitches until they heal. A brace rather than a cast is generally all that is required and you can walk on it straight away. Having an operation means -
- Risks of an operation- anaesthetic and in 5% to 10% wound healing problems, infection or nerve injury.
- Decreased risk of the tendon rupturing again (1% to 4%).
- Quicker rehabilitation and recovery.
- There may be less long term weakness noted- this may be important to more athletic patients and those involved in more explosive sports.
When can I get back to sport after an Achilles rupture?
Providing the tendon rupture is treated in good time then most people do manage to get back to their previous sporting activities and exercise regimens. After surgery and appropriate Physiotherapy most people get back to jogging after three months and can get back to more intense sports involving sprinting and jumping by six months.
When can I return to work after surgery?
This will depend on the type of work you do-
- Sedentary jobs: Return to work after 1 week if able to maintain foot elevated at level of waist, otherwise 2 weeks off.
- Standing/walking jobs: Return after 4 to 6 weeks, but may be sooner depending on comfort and swelling.
- Manual/labouring jobs: 8+ weeks, but may be sooner depending on comfort and swelling.
When can I drive after surgery?
The DVLA state that it is the responsibility of the driver to ensure they are fit and able to stay in control of their vehicle. A good guide is if you can stamp down hard with the foot comfortably and are able to perform an emergency stop then you may be ready to drive. For left sided surgery in an automatic car i.e. no clutch is required, driving is probably safe 1 week after surgery. For right sided surgery or a manual car, driving is probably safe at 6 weeks after surgery, once in a normal shoe. If you are unsure please ask Mr. Al-Nammari. It remains your responsibility to drive safely and you should check with your vehicle insurer to confirm you are covered.
Achilles tendon repair is a fairly small procedure and takes approximately 45 minutes to be performed. It can be undertaken as a day case under local anaesthetic block making the leg numb for six to twelve hours. You will be seen by an Anaesthetist and can be awake, sedated or have a general anaesthetic during surgery. It is possible to walk straight away after the operation with a special brace. There is no need for a cast or prolonged immobility with modern surgical techniques. Mr. Al-Nammari undertakes the majority of his private operating at The Nuffield Hospital in Ipswich. Using the latest techniques in local anaesthetic blocks means that most people having surgery are comfortable enough to get home on the day of surgery should they so wish. For those who need to or just feel more comfortable spending the night in hospital after surgery this is of course possible. The choice of anaesthetic is based upon your own preferences and the opinion of the Consultant Anaesthetist who you will meet before any surgery. Many people prefer to be asleep during surgery and have the local anaesthetic block performed while asleep to control any post-operative pain.