Monday, January 1, 2018

PT Pathologies: Achilles Tendon Rupture

The achilles tendon is the largest and strongest tendon in the human body, made of fibrous connective tissue that connects the calf muscles to the heel bone.  An achilles tendon rupture is a common injury affecting the lower leg, which consists of a tear through the tendon, usually occurring two inches or so above the heel.  An achilles tendon rupture is more liely to occur in the following situations: when the tendon has undergone degenerative changes, overuse, wearing high heels, flat feet, tight muscles or tendons in the leg, and abrupt tensing of the calf muscles.  The level of the tear, partial or complete, determines whether the patient will need surgical or non surgical treatment.  Patients that do get surgery have a lower re-rupture rate (0-5%) than a patient who does not get surgery (40%).  This type of injury is more common in people who play recreational sports and those over 30 years old.

        A patient who has a tendon rupture is unable to move efficiently and may enter the clinic with complaints of pain (possibly severe) and swelling near the heel, an inability to flex the foot or "push off" the injured leg when walking, a palpable defect in the tendon and visible bruising.  The actual diagnosis relies on the symptoms, patients history of the event in which they may hear a popping or snapping noise, and a physical examination.  If the tendon is completely ruptured, the physician can feel a gap in the tendon.  A physician may ask the patient to knee on a chair so the calf muscle can be squeezed to see if the foot automatically flexes.  This is called a Thompson's test, if it does not flex, it indicates a positive rupture.

        It is important to protect the injured tendon to ensure adequate healing time and prevent further injury.  Recovery from an achilles tendon rupture is a tedious process and can be painful, in a case where pain becomes unbearable NSAIDS, and acetaminophen can be used.  For non surgical treatment the patient will be in a cast for 10 weeks followed by the use of a heel lift for 3-6 months to reduce stress on the tendon  For surgical treatment a cast is work for 6-8 weeks, and after removal the patient will remain in physical therapy for 6-7 months, going through 5 progressive phases of rehabilitation.

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