Achilles Tendon Rupture: Diagnosis, Treatment, and Rehabilitation

Achilles tendon rupture issues?

Hello, Doctor.
I apologize for not asking my previous question clearly and for having some follow-up questions.
Let me rephrase my situation.
I was playing basketball in the park when I suddenly fell while sprinting.
At that moment, I felt a sharp pain in my heel, as if it had been struck.
I went to a nearby orthopedic clinic, where the orthopedic doctor did not use X-rays or MRI but performed an ultrasound.
He told me that I had a "partial rupture" of the Achilles tendon and advised me to go to the hospital for surgery.
After transferring to the hospital, the doctor there also did not use X-rays or MRI; he just examined and looked at my heel and said that the Achilles tendon was completely ruptured, stating that imaging was unnecessary and that I needed traditional surgery.
When I palpated my heel from below upwards, I felt a slight indentation, but I am unsure whether it is a partial or complete rupture.

My first question is about the differing opinions from the two doctors; I am confused about whether it is a "partial rupture" or a "complete rupture." If it is indeed a partial rupture, is surgery not necessary? Or is it still better to perform surgery for repair?
My second question is whether adjustable rehabilitation shoes and soft heel pads are essential items that I should purchase.

My third question is that since hospitals usually provide rehabilitation services, would you recommend seeking additional out-of-pocket physical therapy, or is the hospital's rehabilitation department sufficient?
Thank you very much for your help.

Lü Chá, 30~39 year old female. Ask Date: 2020/08/08

Dr. Chen Bochen reply Orthopedics

Hello, Green Tea.

1.
If surgery has already been performed, the surgeon can directly assess whether there is a complete tear; consulting the surgeon is the most accurate method.
However, even if there is not a complete tear, surgery may still be necessary.

2.
Adjustable rehabilitation shoes are optional, but after surgery, you will need to wear a cast.
Your foot will be very stiff, making it more difficult to walk, and the rehabilitation period will be longer.
Investing in these shoes can be beneficial.

3.
You can start with rehabilitation at the hospital.

Reply Date: 2020/08/08

More Info

Achilles tendon rupture is a significant injury that can occur during activities that involve sudden acceleration or deceleration, such as basketball. The Achilles tendon connects the calf muscles to the heel bone and is crucial for walking, running, and jumping. Understanding the diagnosis, treatment, and rehabilitation process is essential for recovery.

Diagnosis
In your case, the initial diagnosis was made using ultrasound, which can effectively identify tendon injuries. However, the distinction between a partial and complete rupture can sometimes be challenging without advanced imaging techniques like MRI. A complete rupture typically presents with a more pronounced gap in the tendon, often accompanied by a "thump" sensation at the time of injury, while a partial rupture may still allow some function but can lead to pain and weakness.

If there is uncertainty about the extent of the injury, it is advisable to seek further imaging, such as an MRI, which provides a clearer picture of the tendon’s condition. This can help confirm whether the tendon is partially or completely torn and guide treatment decisions.

Treatment Options
Regarding treatment, both partial and complete ruptures can be managed surgically or non-surgically, depending on various factors, including the patient's age, activity level, and the extent of the injury.
1. Surgical Repair: If the tendon is completely ruptured, surgery is often recommended to reattach the tendon to the heel bone. This is typically done through a traditional open surgery or minimally invasive techniques. Surgical repair is generally favored for active individuals who wish to return to high-level sports.

2. Non-Surgical Management: For partial ruptures, non-surgical treatment may involve immobilization in a boot or cast, followed by rehabilitation. However, even in cases of partial tears, surgery may be recommended to prevent future complications or re-rupture, especially in active individuals.

Rehabilitation
Rehabilitation is a critical component of recovery from an Achilles tendon injury. The rehabilitation process typically includes:
- Initial Phase: This phase focuses on reducing pain and swelling. Ice, elevation, and rest are crucial. If surgery is performed, the foot may be immobilized for several weeks.

- Strengthening and Range of Motion: Once healing progresses, physical therapy will focus on restoring range of motion and gradually strengthening the calf muscles and Achilles tendon. This may involve specific exercises and stretches.

- Functional Training: As strength improves, the rehabilitation will progress to functional activities, including walking, running, and jumping drills.

Use of Rehabilitation Equipment
Regarding your questions about adjustable rehabilitation shoes and heel pads, these can be beneficial:
- Adjustable Rehabilitation Shoes: These shoes can provide support and help in the healing process by allowing for adjustments as swelling decreases and mobility improves. They can help in maintaining proper alignment and reducing strain on the tendon.

- Heel Pads: Soft heel pads can provide cushioning and support, alleviating pressure on the Achilles tendon during the early stages of recovery.

Seeking Additional Therapy
As for whether to seek additional physical therapy outside of what the hospital offers, it can depend on your specific needs and the quality of care provided by the hospital's rehabilitation department. If you feel that your recovery is not progressing as expected or if you desire a more personalized approach, seeking additional therapy could be beneficial. A private physical therapist can provide tailored exercises and one-on-one attention, which may enhance your recovery.

Conclusion
In summary, it is crucial to clarify the extent of your Achilles tendon injury through appropriate imaging. Both surgical and non-surgical options are available, and rehabilitation is vital for a successful recovery. Utilizing supportive footwear and considering additional physical therapy can further enhance your rehabilitation process. Always consult with your healthcare provider to determine the best course of action tailored to your specific situation.

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