Achilles Tendon Rupture
Achilles was a great warrior, nearly invincible. He’s known as one of the greatest fighters that ever lived, but he died from a poisonous arrow that lodged in his heel. Vinny Testaverde, Dan Marino, Terrell Suggs, Ryan Howard, Boris Becker and Dwayne “The Rock” Johnson. If you follow sports or variations of sport, you’ve likely heard of several of these athletic warriors. Each one has ruptured their Achilles Tendon during their illustrious athletic career. The athletes’ ruptured tendons did not kill them and each of them actually returned to their respective sports. This is definitely a testament to modern surgical techniques and the surgeons who perform them, to the physical therapists who manage the year-long rehabilitation of these large repairs, and to the fortitude of the athlete on the comeback trail.
The Achilles Tendon is the thickest and strongest tendon in the human body. It connects the gastrocnemius and soleus muscles of the calf to the back of the calcaneus or heel bone. Significant stress is placed on this tendon with every step we take, not to mention when we run, squat or jump.
Injury
Achilles Tendon ruptures are most common among male recreational athletes in their 30s and 40s. When the tendon ruptures, the muscle will furl up slightly, like a window shade and form a ball in the middle of the calf. It’s often described by the patient as feeling as if they’ve been shot in the calf.
Following a rupture, the patient will normally be immobilized for several weeks in a cast or boot until most of the swelling goes down. Both surgical and non-surgical management have proven to be effective for long-term recovery following a rupture.
Rehabilitation
Following immobilization or repair, the patient should begin a structured rehab program that includes mobilization, reduction of swelling, pain management/reduction, gradual strengthening, gait and balance training, and other functional activities.
At the initial evaluation, after taking a thorough history from the patient, the Physical Therapist (PT) will assess the lower leg and ankle. They will make observations and measure:
- The overall size, shape, color, temperature and skin integrity of the ankle
- Ankle Girth
- Ankle Range of Motion (ROM)
- Leg Strength
- How the patient walks - probably with crutches or other assistive device
- The patients ability to perform activities of daily living (ADLs)
Taking that data, the PT will devise appropriate goals and a comprehensive plan to help the patient return to pre-injury form. Following an Achilles Tendon rupture, return to athletics usually requires 6-9 months depending on the severity of the injury and demands of the sport. The treatment plan typically involves:
- ROM - first passive (provided entirely by the PT) and progressed to active (performed by the patient) and then to aggressive stretching
- Strengthening - initially isometric which involves no movement and ultimately to concentric and eccentric strengthening exercises
- Progressive Weight Bearing activities - from non-weight bearing, to partial weight bearing, to full weight bearing, the objective is to gradually load the tendon without putting enough strain on it to interfere with healing
- Aquatic Therapy - walking and exercising in a pool allows for controlled weight bearing during functional activities and the facilitation of movement in water. The Hydroworx pool at WSPT has parallel bars and a treadmill built in to the floor, allowing for gait training in a partial weight bearing environment. This is an ideal situation for the rehabilitation of a ruptured Achilles.
- Massage - utilized to reduce swelling and promote fresh blood flow in the lower leg area
- Functional activities - once a patient is safe to stand on their injured leg, we can introduce everyday activities, making them more challenging as tolerated
- Athletic simulation - eventually an athlete will want to get back on the field or court and they should work on the elements of their sport in a controlled environment. Progressively challenging activities can be added to the program to assure for safety and promote increased game readiness.
Overall, the prognosis following a ruptured Achilles Tendon is very good. Whether a surgical or non-surgical approach is taken, most patients fully recover within a year. The caveat is that the rehab process takes a great deal of work on the part of the patient and the PT. Working together, there’s a great chance of recovery and continued success.
