Orthopaedic Procedures | Achilles Tendonitis

Sudden acute strain whilst playing tennis, squash, football can cause strain on the tendon and rupture in the middle aged people. Sometimes the strain is at the musculotendinous junction.

 

Achilles Tendon Rupture: In severe cases, the force may even rupture the tendon. The typical example is the middle aged tennis player who places too much stress on the tendon and experiences a rupture of the tendon.

 

Few centimetres above its attachment tendon is thickened and tender in Achilles tendoniitis. Pain is present with walking, especially when pushing off on the toes.

 

Rupture is an acute event associated with a snap and one feels as if he has been kicked in the calf. One loses the power to push-off and in acute situtation one hobbles and is unable to put much weight through the leg.

 

Conservative treatment for retrocalcaneal bursitis and Achilles tendonitis usually consists of a combination of rest, anti-inflammatory medication, and physical therapy (below). A cortisone injection for this condition is hazardous, due to increased risk of rupture of the tendon following the injection. An aircast boot or a cast immobilisation for 4 to 6 weeks can be helpful.

 

Conservative treatment for rupture of the tendon involves immobilisation in an above knee cast with plantarflexion for 8 weeks and then in neutral position for a further 4 weeks. Some kind of preventive measure for DVT is necessary. However rerupture risk with this regime is higher than operative treatment.


Surgery

 

For tendon ruptures open repair is needed. This involves an incision along the tendon and apposition of the tendon with sutures. Post-operative cast immobilisation is for 12 weeks.
In severe cases of Achilles tendinitis, surgery may involve removing any inflammatory and degenerative tissue around the tendon and heel bone.


Rehabilitation

 

In early phase of tendonitis, ice, rest, orthotic treatment, and stretching can be helpful. In late stages of healing one can use modalities such as contrast bath, friction massage, ultrasound, range of motion exercises, stretching, early strengthening, treadmill walking and orthotics.