Achilles Ruptures

Achilles Ruptures

Achilles ruptures occur most often in the “weekend warrior” – men in their 30s to 50s who play competitive sports a few times per week. It occurs at a 12:1 ratio of men to women. It often occurs during jumping or explosive sports or activities including playing basketball, volleyball, or pushing something heavy. Patients will report hearing a “pop” and feeling like they were kicked in the back of the leg. After the tendon rips, most patients will not have much pain, just weakness with walking. This is why it is a commonly missed injury.

The Achilles tendon is the strongest and largest tendon in the body. It helps with push-off strength during walking, jumping, and running. It connects your calf muscle (gastrocnemius and soleus muscles) to your foot, attaching on the calcaneus (heel bone).

Whether you decide to proceed with surgery or nonoperative management depends on many factors. Regardless, patients will follow a specific rehabilitation protocol researched and created by Dr. Kohring. This has led to successful recovery in her patients who have followed the protocol and were consistent with their rehab and physical therapy.

The decision to proceed with surgery or conservative management depends on many factors including a patient’s age, activity level, medical conditions, smoking status, life goals, priorities, and other life demands. Dr. Kohring will be happy to discuss the pros and cons of surgery with you in the office and support any decision you make.

The Achilles tendon will heal based on the principle that if the ends of the tendon are touching, it will create scar tissue and heal the tendon. The key is ensuring that the tendon is at the correct tension/length to allow for healing. You will be placed into a walking boot with a large heel lift as part of your rehab to ensure the tendon heals at the correct length. Please see Dr. Kohring’s Achilles Rehabilitation Protocol for more information.

Surgical Options

Dr. Kohring is trained in both the traditional open Achilles repair method and the minimally invasive Achilles repair technique. The type of surgery will depend on the type of rupture, length of time since the injury, and other patient factors. There are several potential advantages of surgery including increased plantarflexion strength and a lower re-rupture rate than nonoperative management.

The minimally invasive technique has the advantage of a smaller incision, less wound risks, and less suture in the tendon, which can lead to a quicker recovery and less complications than the traditional open method.

Delay in Treatment

Many Achilles ruptures are missed on initial evaluation 30 to 40% of the time. If the tendon has been ruptured beyond 3 to 4 weeks, this can lead to a gap between the tendon edges and healing of the Achilles tendon in a lengthened position. This will result in ankle plantarflexion weakness and difficulty with walking, running, jumping, and balance. 

Dr. Kohring has extensive training and experience with the treatment in delayed diagnosis, missed Achilles ruptures, and re-ruptures. Dr. Kohring will order an MRI of your ankle and review your treatment options with you in the office. There are many successful surgical treatment options, including lengthening of the calf muscle and transfer of the flexor hallucis longus tendon to repair your Achilles tendon and restore your normal walking gait and plantarflexion strength.