Achilles Tendon Rupture

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1 Achilles Tendon Rupture Exceptional healthcare, personally delivered

2 Following your consultation you have been diagnosed with a ruptured achilles tendon This leaflet aims to give you further information about your condition and treatment. Please ask your surgeon if you have any further questions. What is the Achilles tendon? The Achilles tendon or heel cord is the thick strap that can be felt running down the back of the calf into the heel. The tendon is made up of many bundles or fibres of a strong material called collagen, which is the body s main tissues building block. It is attached to and worked by the 2 large muscles that make up the calf (called gastrocnemius and soleus). When the Achilles tendon pulls on the heel it makes us go up on tiptoe or (toes pointing down wards) or pushes us forwards when walking or running. How is it injured? An injury can occur through sport, in particular it is common in squash and badminton due to the lunging type movement, sudden slipping such as pushing a car or due to specific medical conditions or medication combinations such as steroids and antibiotics. It can also occur when there has been long-term tendonitis. This is where the tendon becomes swollen and painful and this leads to small tears within the tendon. These tears cause the tendon to become increasingly weak and therefore more susceptible to rupture. Definition Achilles tendon rupture is a condition where the tendon has become torn either fully or partially usually behind the ankle but can also be a little higher where it joins the calf muscle. Signs and symptoms When a rupture occurs you may experience a sudden pain in your heel or calf. It has been described as if you have been hit or kicked in your calf causing sudden pain. You may not be able to move your foot upwards and feel uncontrolled in movement. 2 Achilles tendon rupture

3 Treatment This can be treated conservatively or surgically. This will be the decision of the orthopaedic surgeon when reviewing your ruptured Achilles tendon. Both treatments follow the same Achilles tendon rupture guidelines and the length of treatment remains the same. n Diagnosis will occur when seen in the emergency department or minor injuries unit where you will be put into a below knee half plaster or back slab with your foot pointing downwards. n You will then be seen in the new fracture clinic in orthopaedic outpatients the following day. You will be assessed by an orthopaedic surgeon who will examine your foot and discuss with you the plan of care. This may involve an ultrasound scan of the tendon to see the extent of the injury. This will help the surgeon to decide the appropriate treatment for you. When a treatment decision has been decided you will require a below knee cast with toes pointing downwards for at least 2 weeks. n If you do have an operation for your ruptured tendon, the cast will be removed 2 weeks later for wound assessment and removal of sutures. n All casts will be removed between 2-4 weeks with either treatments and a removeable boot applied known as a range of movement (ROM)boot. n You will be given a guidelines plan for you to follow and full instruction on how to look after the skin, tendon and boot. This boot will be applied with toes pointing downwards and slight movement allowed but locked at 30 degrees, toes pointing downwards. You will visit the plaster room regularly over the next 6 weeks for adjustments of the boot until you are able to walk on the boot and the ankle will be at 90 degrees or neutral. You will also be referred to physiotherapy immediately after the boot can Achilles tendon rupture 3

4 be removed. n You will finally be seen again by a member of the team in the fracture clinic when the boot will be removed. Preventing recurrence You have been wearing a Rom boot to protect your healing ruptured Achilles tendon. During the first six weeks after removal of the boot there is a risk that the tendon could rupture again. 9 out of 10 cases of re-rupture occurs within the first six weeks. We advise you to avoid sudden overstretching of the tendon during this time. Protecting the tendon You can protect the tendon from further injury by wearing shoes with a heel, no less than 1 inch or 2.5cm and both shoes should be of the same height. A lace up shoe is advisable as it can be adjusted to any swelling and does not slip around the ankles. Do n Take care when walking on rough, soft or uneven ground as the ground could suddenly force your foot upwards. n Do make sure your foot is flat on stairs, steps or kerbs with your heel on the step to prevent it jerking backwards. n Wear your shoes every time you get up to walk. n Wear your heel raise if you have been given one in all your shoes. n Gradually increase stretching exercises, walking, swimming and take great care when barefoot. Don t n Put your full weight on your bare foot especially when bathing or showering or on slippery surfaces. 4 Achilles tendon rupture

5 n Start driving until you can safely perform an emergency stop and can walk unaided. Take advice from your doctor or physiotherapist. To Observe and Report during treatment n Sudden cramp like pain in calf,thigh or groin. n Pain in chest or shortness of breath. n Sudden increase in swelling,numbness or pins and needles. n Wound concerns. Please speak to plaster room staff or if out of hours contact GP or emergency department. References and Further information The British Orthopaedic Association Lincolns Inn fields, London. Website NHS Constitution. Information on your rights and responsibilities. Available at Achilles tendon rupture 5

6 If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice. North Bristol NHS Trust. This edition published May Review due May NBT002021