eMedicine Specialties > Sports Medicine > Foot and Ankle

Achilles Tendon Rupture: Follow-up

Author: Brian A Jacobs, MD, FACSM, Consulting Staff, Private Practice, Family Medicine of South Bend; Team Physician, Marian High School
Coauthor(s): David Y Lin, MD, Fellow, Department of Orthopedic Surgery, Section of Pediatrics, University of Tennessee Campbell Clinic; Evan Schwartz, MD, Director of Orthopedic Surgery, New York Medical College; Assistant Professor, St John's Queens Hospital, Department of Surgery, Albert Einstein School of Medicine
Contributor Information and Disclosures

Updated: Jun 24, 2009

Follow-up

Return to Play

Return to play following an Achilles tendon rupture is dependent on the method of treatment (operative vs nonoperative). (See Treatment.)

Complications

  • Following nonoperative treatment, the incidence of rerupture is higher (up to 40%).
  • Surgical repair results following rerupture are poorer when compared with the initial operative treatment of an acute tendon rupture.
  • Operative treatments have several complications, including wound complications (eg, infection, skin slough, sinus formation), adhesions, and possible sural nerve injury (especially through a lateral longitudinal approach).

Prevention

Good conditioning and proper stretching is important in the prevention of Achilles tendon injuries. Adequate warm-up is always encouraged before participation in activities that place the Achilles tendon at risk.

Prognosis

With proper treatment and rehabilitation, the prognosis following an Achilles tendon rupture is good to excellent. Most athletes are able to return to their previous activity levels with either surgical or conservative treatment. However, individuals who undergo surgical treatment are less likely to experience rerupture of their Achilles tendons. The rerupture rate for operative treatment is 0-5%, compared with nearly 40% in those who opt for conservative treatment.

Education

Individuals should be educated on the importance of stretching and proper conditioning to prevent rerupture of the Achilles tendon. Wearing appropriate and properly fitting shoes during activities also should be stressed to all athletes.

Miscellaneous

Medicolegal Pitfalls

  • Misdiagnosing and/or delaying treatment for an Achilles tendon rupture are potential medicolegal pitfalls. Upon presentation, patients may be able to weakly plantar flex their ankles due to the intact peroneal muscles, posterior tibialis tendon, or flexor hallucis tendons; therefore, misdiagnosis or delay in treatment may occur because the condition is believed to be just a sprain.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Henry Marano, MD, to the development and writing of this article.



More on Achilles Tendon Rupture

Overview: Achilles Tendon Rupture
Differential Diagnoses & Workup: Achilles Tendon Rupture
Treatment & Medication: Achilles Tendon Rupture
Follow-up: Achilles Tendon Rupture
References
Further Reading
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References

  1. [Best Evidence] Khan RJ, Fick D, Keogh A, et al. Treatment of acute Achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg Am. Oct 2005;87(10):2202-10. [Medline].

  2. Schepsis AA, Jones H, Haas AL. Achilles tendon disorders in athletes. Am J Sports Med. Mar-Apr 2002;30(2):287-305. [Medline].

  3. Keene JS. Tendon injuries of the foot and ankle. In: DeLee JC, Drez D, eds. Orthopaedic Sports Medicine. Philadelphia, Pa: WB Saunders; 1994:1768-1805.

  4. Maffulli N. Rupture of the Achilles tendon. J Bone Joint Surg Am. Jul 1999;81(7):1019-36. [Medline]. [Full Text].

  5. Moore KL. Clinically Oriented Anatomy. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1999.

  6. Carr AJ, Norris SH. The blood supply of the calcaneal tendon. J Bone Joint Surg Br. Jan 1989;71(1):100-1. [Medline]. [Full Text].

  7. Kader D, Saxena A, Movin T, Maffulli N. Achilles tendinopathy: some aspects of basic science and clinical management. Br J Sports Med. Aug 2002;36(4):239-49. [Medline]. [Full Text].

  8. O'Brien T. The needle test for complete rupture of the Achilles tendon. J Bone Joint Surg Am. Sep 1984;66(7):1099-101. [Medline]. [Full Text].

  9. Saltzman CL, Tearse DS. Achilles tendon injuries. J Am Acad Orthop Surg. Sep-Oct 1998;6(5):316-25. [Medline].

  10. Puddu G, Ippolito E, Postacchini F. A classification of Achilles tendon disease. Am J Sports Med. Jul-Aug 1976;4(4):145-50. [Medline].

  11. Clement DB, Taunton JE, Smart GW. Achilles tendinitis and peritendinitis: etiology and treatment. Am J Sports Med. May-Jun 1984;12(3):179-84. [Medline].

  12. Metz R, Verleisdonk EJ, van der Heijden GJ, et al. Acute Achilles tendon rupture: minimally invasive surgery versus nonoperative treatment with immediate full weightbearing--a randomized controlled trial. Am J Sports Med. Jul 21 2008;epub ahead of print. [Medline].

  13. [Best Evidence] Twaddle BC, Poon P. Early motion for Achilles tendon ruptures: is surgery important? A randomized, prospective study. Am J Sports Med. Dec 2007;35(12):2033-8. [Medline].

  14. Chalmers J. Review article: Treatment of Achilles tendon ruptures. J Orthop Surg (Hong Kong). Jun 2000;8(1):97-99. [Medline]. [Full Text].

  15. Cetti R, Christensen SE, Ejsted R, Jensen NM, Jorgensen U. Operative versus nonoperative treatment of Achilles tendon rupture. A prospective randomized study and review of the literature. Am J Sports Med. Nov-Dec 1993;21(6):791-9. [Medline].

  16. Ma GW, Griffith TG. Percutaneous repair of acute closed ruptured achilles tendon: a new technique. Clin Orthop Relat Res. Oct 1977;128:247-55. [Medline].

  17. Elliot RR, Calder JD. Percutaneous and mini-open repair of acute Achilles tendon rupture. Foot Ankle Clin. Dec 2007;12(4):573-82, vi. [Medline].

  18. DeLee JC, Drez D Jr, Miller MD, eds. Orthopaedic Sports Medicine. 2nd ed. Philadelphia, Pa: WB Saunders; 2003.

  19. [Best Evidence] Pajala A, Kangas J, Siira P, Ohtonen P, Leppilahti J. Augmented compared with nonaugmented surgical repair of a fresh total Achilles tendon rupture. A prospective randomized study. J Bone Joint Surg Am. May 2009;91(5):1092-100. [Medline].

  20. Balasubramaniam P, Prathap K. The effect of injection of hydrocortisone into rabbit calcaneal tendons. J Bone Joint Surg Br. Nov 1972;54(4):729-34. [Medline]. [Full Text].

  21. Bring DK, Reno C, Renstrom P, et al. Joint immobilization reduces the expression of sensory neuropeptide receptors and impairs healing after tendon rupture in a rat model. J Orthop Res. Jul 24 2008;epub ahead of print. [Medline].

  22. Maffulli N, Ajis A. Management of chronic ruptures of the Achilles tendon. J Bone Joint Surg Am. Jun 2008;90(6):1348-60. [Medline]. [Full Text].

  23. Neuhold A, Stiskal M, Kainberger F, Schwaighofer B. Degenerative Achilles tendon disease: assessment by magnetic resonance and ultrasonography. Eur J Radiol. May-Jun 1992;14(3):213-20. [Medline].

  24. Thompson TC, Doherty JH. Spontaneous rupture of tendon of Achilles: a new clinical diagnostic test. J Trauma. 1963;12:126-9.

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Keywords

Achilles tendon rupture, Achilles tendon tear, Achilles tendon injury, Achilles tendon pathology, Achilles injury, Achilles tendon repair, Achilles tendon surgery

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Contributor Information and Disclosures

Author

Brian A Jacobs, MD, FACSM, Consulting Staff, Private Practice, Family Medicine of South Bend; Team Physician, Marian High School
Brian A Jacobs, MD, FACSM is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, and American Medical Society for Sports Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

David Y Lin, MD, Fellow, Department of Orthopedic Surgery, Section of Pediatrics, University of Tennessee Campbell Clinic
David Y Lin, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons
Disclosure: Nothing to disclose.

Evan Schwartz, MD, Director of Orthopedic Surgery, New York Medical College; Assistant Professor, St John's Queens Hospital, Department of Surgery, Albert Einstein School of Medicine
Evan Schwartz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine
Disclosure: Nothing to disclose.

Medical Editor

David T Bernhardt, MD, Director of Adolescent and Sports Medicine Fellowship, Associate Professor, Department of Pediatrics, University of Wisconsin
David T Bernhardt, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Sports Medicine, and American Medical Society for Sports Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

 
 
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