Achilles Tendon Tears: Treatment Options

Achilles Tendon Tears: Treatment Options

Speaker1: The Achilles tendon functions to provide strength when pushing off with our feet during activities such as running, walking, and jumping. An Achilles tendon tear results in pain and loss of these functions. If left untreated, the tendon may not heal, or the body tries to heal the tendon with the formation of scar tissue. When the tendon heals with scar tissue, it often leaves the tendon in an elongated, abnormal position. Healing at an abnormal length can lead to continued pain and dysfunction with activities of daily life, such as walking.

After an Achilles tendon tear, it is important to seek care quickly. After a doctor evaluates and confirms the diagnosis of Achilles tendon tear, they will take many factors into consideration when deciding whether to treat the tear with nonoperative versus operative management. These include, but are not limited to, the general health of the patient, current activity level, patient desires, and tear thickness. Nonoperative treatment is typically chosen for patients who are less active or are not healthy enough to undergo surgical management. Nonoperative management has evolved over the years and now consists of early weight bearing to the injured leg while wearing a functional brace versus a rigid cast. The goal of the functional brace is to prevent the toes from drifting upwards, which can stretch the torn ends of the Achilles tendon further apart and cause it to heal at a longer length than normal.

Speaker1: Range of motion is introduced after a period of immobilization in the brace, with a gradual return to activities. Surgical repair of the Achilles tendon is often recommended for active patients, so let us talk about what that might look like. On the day of surgery, the patient will be positioned on the operating table on their stomach, known as the prone position, with the affected foot hanging off of the table. This places the back of the lower leg facing up towards the surgeon. Once positioned, the surgeon has the choice of performing the repair through an open or minimally invasive incision. An open incision would be made on the back of the leg in a vertical fashion that allows the surgeon to have increased visibility of the torn tendon ends. Once the torn ends of the tendons are exposed, sutures are passed through the ends. The sutures from the top and bottom portion of the tendon are then tied together with knots to reapproximate the tendon. The minimally invasive incision involves a small horizontal incision that is positioned at the level of the tear.

Speaker1: A specialized instrument is introduced into the incision that allows for the sutures required to repair the tendon to be passed without the need for a larger incision. Once the sutures are passed through the tendon ends, like the open approach, the ends can be tied together using knots. A modification to this technique is using a knotless configuration. The knotless configuration eliminates a knot stack that patients may feel through their skin after surgery. Here, once the sutures are placed in the tendon, they are passed down towards the heel, under the skin, and secured into the heel bone using hard body anchors through two additional tiny incisions.

Following surgery, guidelines for recovery will be specific to the patient's needs and surgeon's preferences. Generally, there is a period of non-weight-bearing to the affected leg in either a cast or a boot, followed by partial weight-bearing in a walking boot. Finally, progressing to full weight-bearing with range of motion and strengthening exercises. No matter which way the surgeon chooses to treat the Achilles tendon tear, the goal remains the same: to bring the tendon ends back together, thereby restoring function to the calf so patients can return to their daily activities.