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Treatment and Physiotherapy Management of Torn Achilles Tendon
The largest and strongest tendon in the body is the Achilles tendon on the distal back of the calf. The typical patient for an Achilles tendon rupture is a healthy male between the ages of 30 and 50 who has not had any previous major injuries or problems with the leg. Fractures often occur in people who have been inactive recently, and they may indulge in infrequent physical activity, such as participating in weekend sports, known as “weekend warriors.”
The gastrocnemius and soleus, two large calf muscles, each have a tendon that converges about 15 cm above the calcaneus to form the Achilles tendon. Tendons transmit force from muscle to bone, for which they have high elasticity and sufficient stiffness, good tensile strength, and allow 4% stretch before injury. When the stretch reaches 8%, fiber damage and breakage may occur. Most tendon ruptures and degenerations occur where the blood supply is poorest, approximately 2-6 cm from the heel bone.
Most Achilles tendon tears occur in the left leg, which has poor blood supply, probably because most people are right-handed and push more with the left leg. Common injuries are sudden push off of the foot, unexpected force on the ankle and upward force on the ankle when pushing down. Direct trauma and generalized degeneration of the tendon without trauma can also occur. Those at risk include those who exercise themselves when they are not fit, the relatively older, steroid users and those who exercise themselves in extreme ways.
Achilles tendon strength during running can be very strong, measuring six to eight times your body weight. Patients typically report a sudden snap or impact on the back of the lower leg, sudden severe pain, and are able to walk but not run or climb stairs. Examination may reveal swelling or bruising of the lower leg, palpable gaps in tendons, and inability to stand on tiptoes. A history of steroid therapy, previous tendon ruptures, or unusually high activity levels (such as weekend warriors) may also be important findings.
Using conservative or surgical treatment, there were more reruptures without surgery. The elderly, sedentary persons, those with poor skin healing, and some medical conditions are more suitable for conservative treatment. Infection, wound or repair failure, and other complications are more common in diabetes, peripheral vascular disease, and other conditions that impair healing. A short-leg or long-leg cast can be applied in plantarflexion, gradually moving the ankle upward over a period of six to ten weeks. Once the foot is fairly flat, weight bearing is allowed and the patient is placed in an adjustable orthosis.
The surgery can be open or percutaneous, after which the ankle is held in plantar flexion in a plaster of paris or rigid orthosis, and the patient comes back to allow the ankle to be repositioned upward while the tendon heals until four to six weeks after the ankle has been repaired off the splint. Shorter fixed times seem to be more successful than longer ones. Overall surgical repair may have a lower rate of rerupture, faster return to normal, and better strength and endurance than conservative treatment.
Physical therapists can now begin a rehabilitation program, perform range-of-motion exercises without body weight, teach normal gait patterns and raise the heels to limit forced dorsiflexion while walking. Swimming and static cycling are good initial exercises that progress to weight-bearing exercises, strength exercises, and finally dynamic exercises such as balance, running, and jumping. The time to return to normal activities varies, but may be up to four months after surgery.
The outcome of an Achilles tendon rupture is usually good to excellent, and most athletes can return to normal activities. However, surgically repaired tendons have a re-rupture rate of 0-5%, compared with nearly 40% for conservatively treated tendons. Patient education is important to continue with proper training, stretching to reduce the chance of re-rupture, and proper footwear selection.
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#Treatment #Physiotherapy #Management #Torn #Achilles #Tendon