Achilles Tendon Rupture Repair With Flexor Hallucis Longus Exercises

Overview
Achilles tendon is a strong fibrous cord present behind the ankle that connects the calf muscles to heel bone. It is used when you walk, run and jump. When the Achilles tendon becomes thin, weak, or if it is not used, it may be susceptible to injury or damage. Achilles tendon rupture occurs most often in middle-aged athlete participating in sports that involve running, pivoting, and jumping. Recreational sports that may cause Achilles rupture include tennis, racquetball, basketball, and badminton.

Causes
Your Achilles tendon helps you point your foot downward, rise on your toes and push off your foot as you walk. You rely on it virtually every time you move your foot. Rupture usually occurs in the section of the tendon located within 2 1/2 inches (about 6 centimeters) of the point where it attaches to the heel bone. This section may be predisposed to rupture because it gets less blood flow, which also may impair its ability to heal. Ruptures often are caused by a sudden increase in the amount of stress on your Achilles tendon. Common examples include increasing the intensity of sports participation, especially in sports that involve jumping, falling from a height, stepping into a hole.

Symptoms
Patients with an Achilles tendon rupture frequently present with complaints of a sudden snap in the lower calf associated with acute, severe pain. The patient reports feeling like he or she has been shot, kicked, or cut in the back of the leg, which may result in an inability to ambulate further. A patient with Achilles tendon rupture will be unable to stand on his or her toes on the affected side.

Diagnosis
A staggering 20%-30% of Achilles tendon ruptures are missed. Thompson (calf squeeze) test is 96% sensitive and 93% sensitive. Unfortunately, some health practitioners fail to perform this simple clinical test. Ultrasound examination or an MRI can confirm an Achilles tendon rupture.

Non Surgical Treatment
Two treatment options are casting or surgery. If an Achilles tendon rupture is untreated then it may not heal properly and could lead to loss of strength. Decisions about treatment options should be made on an individual basis. Non-surgical management traditionally is selected for minor ruptures, less active patients, and those with medical conditions that prevent them from undergoing surgery. The goal of casting is to allow the tendon to slowly heal over time. The foot and ankle are positioned to bring the torn ends of the tendon close together. Casting or bracing for up to 12 weeks or more may be necessary. This method can be effective and avoids some risks, such as infection, associated with surgery. However, the likelihood of re-rupture may be higher with a non-surgical approach and recovery can take longer.

Surgical Treatment
Regaining Achilles tendon function after an injury is critical for walking. The goal of Achilles tendon repair is to reconnect the calf muscles with the heel bone to restore push-off strength. Those best suited for surgical repair of an acute or chronic Achilles tendon rupture include healthy, active people who want to return to activities such as jogging, running, biking, etc. Even those who are less active may be candidates for surgical repair. Non-operative treatment may also be an option. The decision to operate should be discussed with your orthopaedic foot and ankle surgeon.

Prevention
The following can significantly reduce the risk of Achilles tendon rupture. Adequate stretching and warming up prior to exercising. If playing a seasonal sport, undertake preparatory exercises to build strength and endurance before the sporting season commences. Maintain a healthy body weight. This will reduce the load on the tendon and muscles. Use footwear appropriate for the sport or exercise being undertaken. Exercise within fitness limits and follow a sensible exercise programme. Increase exercise gradually and avoid unfamiliar strenuous exercise. Gradual ?warm down? after exercising.