Achilles tendon Tears

The achilles tendon was named after the Greek god Achilles.  This was the only part of his body that was still vulnerable after his mother dipped him in the River Styx.  This strong tendon connects your calf muscle (The gastrocnemius and soleus) to the heel bone (calcaneus). It lets you stand up on your toes, push off while you are walking,  jump, and run.  It is the largest tendon in your body.  

Achilles tendon injury

Achilles tendon injuries happen in younger and mid aged people.  Most of my patients feel as if they were struck in the back of the calf with a baseball bat, and suddenly couldn’t walk. This may happen because your calf muscle is too tight, but in some cases its just the right combination of forces at the time of the injury.   

Making the diagnosis of Achilles tendon tear

Achilles Tendon RuptureSeeing the right doctor is important.  To me, this is a diagnosis made on physical examination.   There is usually a gap in the tendon that you can feel.  Whether you see your primary doctor, or can get in to an orthopedic surgeon, be sure to be seen within a day or two of the injury.  For a doctor that is unsure of the diagnosis, and MRI scan can be helpful to confirm the tear, but to me, this is really a diagnosis you can literally ‘feel’.  The ends of the tendon are usually obvious to a well-trained physician.   Ordering the MRI, getting authorization for it, scheduling it, and waiting for the result can take time, and if needed, surgical repair should happen soon after the injury.  I don’t like to wait more than about 14 days to fix these from the date of injury.

Treatment of Achilles tendon tears

There is plenty of evidence that Achilles tendon tears can be treated without surgery.  In fact, studies have shown that the overall complication rate is about the same with and without surgery.    Non-surgical treatment requires the ends of the torn tendon be touching each other and held in place for at least 6 weeks.  To do this, you will need to be in a cast or walking boot with your toes pointed down all the way.    The other option is to have a surgical procedure in which the ends of the tendon are sewn together.  In my experience (not specific medical advice!), surgical treatment will have a significantly better chance of giving you a great result.   I have not seen the immobilization method to work well.   The most common surgical complication is trouble with incision healing.  I feel that a skilled surgeon can use a variety of techniques to ensure this risk is as low as possible.  

Rehab after surgery for Achilles tendon tears

Rehab after an achilles repair initially focuses on allowing the tendon to heal.   I wish you could make time go faster!  It takes about 6 weeks for the ends of the torn Achilles tendon to knit itself back together.  It’s not normal at that point, but on its way to healing.  For me, I manage patients in a splint with the toes pointed down for 2 weeks, then take out the stitches and put them in a cast, but with the foot angled a little closer to normal, as if you were standing on the ground.  A second cast is put on at a month out after surgery with still more bend closer to normal.  By 6 weeks, most patients are ready to go into a walking boot and start physical therapy.  At 10 weeks, you can wear a regular shoe , but I would still caution you on doing stairs.  

Recovery takes time.  I have a healthy respect for the healing of this tendon.  It will take several months before you are able to stand up on your toes  – maybe longer than you realize.  I tell all my patients to be ‘patient’ and understand it will take time.  The goal is a normal leg!  Most get there at about 6-8 months.   

Questions about Achilles tendon tears

Remember, there is no one treatment that is right for everyone. I have seen a lot of people in San Diego with tears and have taken many patients through the rehabilitation process.  Please let me know if you have questions about achilles tendon tears.