Achilles’ tendon problems

Complaints in the Achilles’ tendon area
Achilles’ tendon problems are a particularly common reason for medical consultations in active and athletic middle-aged patients. Alongside acute rupture of the Achilles’ tendon, degenerative inflammatory diseases of the tendon occur commonly.

Degenerative inflammatory diseases of the tendon
When the inflamed tendon is examined, we sometimes find severe thickening along the tendon and sometimes discover a severely shortened calf musculature. Physiotherapy forms the basis of treatment. Complementary to this, or if the symptoms persist, a shock wave therapy is an option, depending on the degree of degeneration (this can be verified using MRI). A surgical restructuring can also become necessary if there are major degenerative changes.

Achilles’ tendon rupture
Achilles’ tendon ruptures tend to occur in cases of previous damage caused by excessive or defective strains. If the rupture is acute, we aim to perform a surgical revision if possible to prevent a partial insufficiency as a result of a lengthening.

The spectrum of surgical options ranges from straightforward revision and the reconstruction of the remaining residual tendon using local tissue to complex reconstruction of the Achilles’ tendon with the flexor hallucis longus tendon. In some indications, open or minimal invasive surgical techniques can be considered.

Rehabilitation
In both procedures, the tendon is usually immobilised for 6 weeks in a lower leg plaster or in a special boot. Following this, a graduated rehabilitation programme is begun. The foot is kept in a splay foot position (roughly 10° to 20°) during this time, which can slowly be reduced in accordance with the particular therapy.

The risk of a new rupture is particularly great in the 8th to 10th week. Gentle jogging on uneven ground can normally be taken up after approx. 4 to 6 months.

The healed Achilles’ tendon never returns to its full strength – as is the case for all other ruptured tendons. If everything runs smoothly, its strength returns to roughly 80 to 90% of that of a healthy tendon. Nevertheless, in the best cases sport can be taken up again without limitation – including competitive sports.