GENERAL ACHILLES RUPTURE INFORMATION FROM THE LEG TEAM
Achilles Tear - What is it?
An Achilles Tear is where some of the fibres that make up the Achiles are torn.
Classification of tear:
Grade 1: Some fibres
Grade 2: Many
Grade 3: Complete rupture
type I: partial ruptures ≤50% -typically treated with conservative management
type II: complete rupture with tendinous gap ≤3 cm -typically treated with end-end anastomosis
type III: complete rupture with tendinous gap 3 to 6 cm often requires tendon/synthetic graft
type IV: complete rupture with a defect of >6 cm (neglected ruptures) often requires tendon/synthetic graft and gastrocnemius recession
Surgery vs Conservative management in Achilles rupture
Bone Joint J. 2017 Jan;99-B(1):87-93. doi: 10.1302/0301-620X.99B1.BJJ-2016-0452.R1.
Functional outcomes of conservatively managed acute ruptures of the Achilles tendon
J E Lawrence et al
Aims: This prospective cohort study aims to determine if the size of the tendon gap following acute rupture of the Achilles tendon shows an association with the functional outcome following non-operative treatment.
Patients and methods: All patients presenting within two weeks of an acute unilateral rupture of the Achilles tendon between July 2012 and July 2015 were considered for the study. In total, 38 patients (nine female, 29 male, mean age 52 years; 29 to 78) completed the study. Dynamic ultrasound examination was performed to confirm the diagnosis and measure the gap between ruptured tendon ends. Outcome was assessed using dynamometric testing of plantarflexion and the Achilles tendon Total Rupture score (ATRS) six months after the completion of a rehabilitation programme.
Results: Patients with a gap ≥ 10 mm with the ankle in the neutral position had significantly greater peak torque deficit than those with gaps < 10 mm (mean 23.3%; 7% to 52% vs 14.3%; 0% to 47%, p = 0.023). However, there was no difference in ATRS between the two groups (mean score 87.2; 74 to 100 vs 87.4; 68 to 97, p = 0.467). There was no significant correlation between gap size and torque deficit (τ = 0.103), suggesting a non-linear relationship. There was also no significant correlation between ATRS and peak torque deficit (τ = -0.305).
Conclusion: This is the first study to identify an association between tendon gap and functional outcome in acute rupture of the Achilles tendon. We have identified 10 mm as a gap size at which deficits in plantarflexion strength become significantly greater, however, the precise relationship between gap size and plantarflexion strength remains unclear. Large, multicentre studies will be needed to clarify this relationship and identify population subgroups in whom deficits in peak torque are reflected in patient-reported outcome measures.
Achilles Tear - How do I know if I have ruptured my Achilles?
You may feel like you have any or all of the following
The feeling of having been kicked or even a gun shot to the calf area
You will initially feel severe Pain
You may have an inability to bend the foot downward or "push off" the injured leg when walking
You will not be anble to fully bear weigtht on your leg and you will have an inability to stand on the toes on the injured leg
A popping or snapping sound when the injury occurs
Achlles rupture - Why did I rupture my Achilles?
The Achlles Tendon is a complex and strong structure that is coimplrised of the Gastrocnemius , Soleus and Plantar muscles that form into a common tendon and attaceh together at your heel.
The Achilles tendon helps you point your foot downward, rise on your toes and push off your foot as you walk.
You rely on it every time you walk and move your foot.
Rupture usually occurs in the section of the tendon situated within about 6 centimeters of the point where it attaches to the heel bone.
This section might be prone to rupture because of blood flow which is relatively poor. Unfortunately this can also impair its ability to heal.
Ruptures often are caused by a sudden increase in the stress on your Achilles tendon.
Common examples include:
Pushing off your foot aggressively
Increasing the intensity of sports participation, especially in sports that involve jumping
Stepping into a hole
RECOMMENDED MEDICAL LITERATURE RESEARCH
A Prospective Randomized Trial Comparing Surgical and Nonsurgical Treatments of Acute Achilles Tendon Ruptures - Iikka Lantto et al 2016
Randomized Controlled Trial
Am J Sports Med. 2016 Sep;44(9):2406-14. doi: 10.1177/0363546516651060. Epub 2016 Jun 15.
Background: The optimal treatment of acute Achilles tendon ruptures for active patients is under debate.
Purpose: To compare clinical outcomes and calf muscle strength recovery after the nonsurgical treatment and open surgical repair of acute Achilles tendon ruptures with identical accelerated rehabilitation programs.
Study design: Randomized controlled trial; Level of evidence, 1.
Methods: From 2009 to 2013, a total of 60 patients with an acute Achilles tendon rupture were randomized to surgery or nonsurgical treatment. Nonsurgical treatment included first a week of cast immobilization, followed by a functional orthosis for 6 weeks, allowing full weightbearing after week 1 and active plantar flexion after week 5. Surgery was simple end-to-end open repair, and postoperative treatment was identical to nonsurgical treatment.
Outcome measures included the Leppilahti Achilles tendon performance score, isokinetic calf muscle strength, and RAND 36-Item Health Survey at 18-month follow-up.
Results: At 18-month follow-up, the mean Leppilahti score was 79.5 and 75.7 for the surgically and nonsurgically treated groups, respectively (mean difference, 3.8; 95% CI, -1.9 to 9.5; P = .19). Angle-specific peak torque results of affected legs showed that surgery resulted in faster and better recovery of calf muscle strength over the entire range of motion of the ankle joint: at 6 months, the difference varied from 16% to 24% (P = .016), favoring the surgically treated group, whereas at 18 months, surgically treated patients had 10% to 18% greater strength results (P = .037). At 18 months, a 14% difference in the peak torque of the affected leg favored the surgical group versus the nonsurgical group (mean peak torque, 110.3 vs 96.5 N·m, respectively; mean difference, 13.6 N·m; 95% CI, 2.0-25.1 N·m; P = .022). The RAND 36-Item Health Survey indicated better results in the domains of physical functioning (P = .006) and bodily pain (P = .037) for surgically treated patients.
Conclusion: Surgical and nonsurgical treatments of acute Achilles tendon ruptures have similar results in terms of the Achilles tendon performance score, but surgery restores calf muscle strength earlier over the entire range of motion of the ankle joint, with a 10% to 18% strength difference favoring surgery at 18 months. Surgery may also result in better health-related quality of life in the domains of physical functioning and bodily pain compared with nonsurgical treatment.
Non-operative functional treatment for acute Achilles tendon ruptures: The Leicester Achilles Management Protocol (LAMP) Randeep S Aujla et al 2019
Injury. 2019 Apr;50(4):995-999. doi: 10.1016/j.injury.2019.03.007. Epub 2019 Mar 11.
Objectives: The purpose of this study is to present outcomes and objective measures of assessment for acute Achilles tendon (AT) ruptures treated with an eight-week functional dynamic treatment protocol in a VACOped® boot with immediate full weight bearing mobilisation, the Leicester Achilles Management Protocol (LAMP).
Methods: A prospective study of all patients treated with the LAMP with minimum 12-month follow-up was performed. Patients completed the Achilles Tendon Rupture Score (ATRS) and in the latter part of the study, objective measures of the calf muscle girth and heel raise height were obtained.
Results: 442 patients were treated with the LAMP. There were nine (2%) re-ruptures in the 442 non-operative treated group of patients throughout the study period. ATRS at twelve months or more were available in 234 patients and objective measures in 77 patients. The mean age was 50 years. The mean ATRS was 75.5 at an average of 23 months post injury. Men had a statistically significant higher ATRS score when compared to women (p < 0.05). There was statistically significant difference in the calf muscle girth and the heel raise height when compared to the uninjured side at 12-months post-injury (p < 0.05). These differences did not correlate with the ATRS (p > 0.05).
Conclusions: The LAMP is a simple yet effective regime for the non-operative treatment of acute AT ruptures, which can be universally adopted without the need for many resources. Compared to other studies, the overall time in the boot is less with low complication rates and similar patient reported outcomes.
GOLD STANDARD TREATMENT OPTIONS FOR ACHILLES RUPTURES
GOLD STANDARD TREATMENT AND REHAB OPTIONS
The Lower Extremity Group offers to you the Gold Standard in Lower extremity injury rehabilitation.
We utilise a World Class rehabilitation program for Achilles tear, and this is deilvered to you online in the comfort of your own home. All you have to do is follow our easy to use evidence based plan to treat and manage your Achilles Pain.
This online program contains 12 complete weeks of revolutionary rehabilitation guides to help you manage and treat your Achilles Tendon issues every single day.
We deliver our evidence-based daily Achilles management program via our amazing app, which is very easy for you to follow and includes;
Progressive neuromuscular exercises that will strengthen the muscles around the foot and ankle and help reduce the pain associated with Achilles tendon injury.
5 progressive levels of evidence based rehabilitation that do not require expensive equpiment
Passive and dynamic mobility exercises to increase range of motion and tissue extensibility of mucles and fascia
Myofascial massage exercises
We offer online consultations as a part of the rehabiliation precess to help you rehabilitate and manage your Achilles tear.
Our experienced therapists have taken these aforementioned technical modalities and simplified them into easy to watch videos for you to follow and complete. These are delivered daily to your smart device within our Achilles management program.
Book in today - Online or in clinic
Using the app will enable you to understand when to apply the various exercises to help manage Achilles rupture