What tests help diagnose a ruptured Achilles tendon?
A health care professional makes a diagnosis of Achilles tendon rupture by taking a patient's history and performing a physical exam as noted above. Imaging may be required to confirm the extent of tendon damage and to look for other associated injuries
Plain X-rays of the foot may reveal swelling of the soft tissues around the ankle, other bone injury, or tendon calcification.
Ultrasound is the next most commonly ordered test to document the injury and size of the tear. For a partial tear of the Achilles tendon, the diagnosis is not always obvious on a physical exam and an ultrasound may be considered. A health care provider or by an ultrasound technician and radiologist may perform a bedside ultrasound.
MRI: Health care providers often order an MRI when a diagnosis of tendon rupture is not obvious on ultrasound or a complex injury is suspected. MRI is an excellent imaging test to assess for presence of any soft-tissue trauma or fluid collection. More importantly, MRI can help detect presence of tendon thickening, bursitis, and partial tendon rupture.
What are treatment options for an Achilles tendon rupture?
Picture 3 shows the type of casts used to treat Achilles tendon injury.
Two options exist for Achilles tendon rupture, one involving surgical repair and the other a conservative treatment (allowing the tendon to heal on its own in a cast). Each has its benefits and risk and decisions will depend upon the patient's clinical situation, underlying medical background, the extent of the injury and the expectation of future activity.
Surgery is the recommended treatment for the young, healthy and active individuals. For athletes, surgery is often the first choice of treatment. The Achilles tendon can be repaired surgically by either a percutaneous or open technique. With the open technique, a physician makes an incision to allow for better visualization and approximation of the tendon. With the percutaneous technique, the surgeon makes several small skin incisions to repair the tendon. Irrespective of type of treatment, a health care professional will apply a short leg cast or postoperative boot on the operated ankle after completion of the procedure (picture 3). Each approach has its benefits and risks and the choice of surgery type is individualized for each specific patient.
The advantages of a surgical approach includes a decreased risk of re-rupture rate (0%-5%); the majority of individuals can return to their original sporting activities (within a short time), and most regain their strength and endurance.
Disadvantages of a surgical approach include cost, the need for hospitalization and wound complications (for example, skin sloughing, infection, sinus tract formation, nerve injury
Nonsurgical method may be recommended for patients who are older, less active, and have a higher risk for surgery and anesthetic. Ability to heal wounds is also an important consideration and may include those with poor blood supply to their feet. These include patients with peripheral artery disease and diabetes.
Nonsurgical management involves application of a short leg cast to the injured leg, with the foot in a slightly downward flexed position. Maintaining the ankle in this position helps bring the ruptured tendon ends closer together to allow them to heal. The leg is placed in a cast for six to 10 weeks and no movement of the ankle is allowed. Walking is allowed on the cast after a period of four to six weeks. When the cast is removed, a small heel lift is inserted in the shoe to decrease the stress on the Achilles tendon for an additional two to four weeks. Following this, physical therapy is recommended.
The disadvantages of the nonsurgical approach includes an increased risk of re-rupture (up to 40%), prolonged immobilization in a cast, and increased technical difficulty should subsequent surgery be required.
The benefits include no need for anesthesia or hospitalization, decreased risk of skin breakdown and decreased risk of nerve damage.