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patrice0lara12

Achilles Tendon Rupture Non Surgical Protocol

Overview
Achilles tendinitis Rupture of the Achilles tendon is a common injury in healthy, young, active individuals. The rupture is typically spontaneous and most commonly observed in individuals in between 24-45 years of age. The majority have had no prior history of pain or previous injury to the heel. In the majority of cases, rupture of the Achilles tendon occurs just a few centimeters above the heel bone. Common causes of Achilles tendinitis or rupture include advanced age, poor conditioning, and overexertion during exercise. In most cases, the individual rapidly performs activity like running or standing on the toes, which generates intense force on the tendon, leading to rupture. Achilles tendon rupture is often described as an abrupt break with instantaneous pain that is felt in the foot or heel area. The pain may radiate along the back of the leg and is often intense. Generally, walking may be difficult and the foot may drag. Most individuals claim that they felt like they were kicked in that area or even shot at. These symptoms lead to a suspicion of rupture of the Achilles tendon. Sometimes the tendon does not fully rupture but only a partial tear develops. The partial tear can also present with pain, and if not recognized, can rapidly develop into a full-blown rupture. In the majority of cases, the Achilles tendon rupture occurs just above the heel, but it may occur anywhere along the length of the tendon.

Causes
A rupture occurs when a patient overstretches the Achilles tendon, an act which causes it to tear partially or completely. Achilles tendon ruptures can occur during athletic play or any time the tendon is stretched in an unexpected way.

Symptoms
Symptoms of an Achilles tendon rupture usually directly follow a traumatic event where the foot is forced in an upward position at the ankle, causing a sudden tight stretch of the Achilles tendon. There can also be a direct blow to the tendon causing a rupture. There is typically a popping feeling or even a popping sound described during the occurance of the rupture. Typically there is pain with swelling in the region. Often the patient is unable to put weight on this foot as there is too much pain.

Diagnosis
Diagnosis is made mostly by clinical examination with a defect usually noted on visual examination and by touching the area. A simple test can be done by squeezing the back of the calf with the foot resting in the air. Normally when squeezing the muscle belly the tendon will shorten causing the foot to move in a downward position. With a rupture this squeezing effect may show no movement of the foot if it is not attached properly. A negative test does not mean there isn't some degree of rupture as some of the tendon fibers may still be attached. Sometimes x-rays, an mri, or an ultrasound can be helpful in determining the extent of the rupture.

Non Surgical Treatment
Non-operative treatment consists of placing the foot in a downward position [equinus] and providing relative immobilization of the foot in this position until the Achilles has healed. This typically involves some type of stable bracing or relative immobilization for 6 weeks, often with limited or no weight bearing. The patient can then be transitioned to a boot with a heel lift and then gradually increase their activity level within the boot. It is very important that the status of the Achilles is monitored throughout non-operative treatment. This can be done by examination or via ultrasound. If there is evidence of gapping or non-healing, surgery may need to be considered. Formal protocols have been developed to help optimize non-operative treatments and excellent results have been reported with these protocols. The focus of these treatments is to ensure that the Achilles rupture is in continuity and is healing in a satisfactory manner. The primary advantage of non-operative treatment is that without an incision in this area, there are no problems with wound healing or infection. Wound infection following Achilles tendon surgery can be a devastating complication and therefore, for many patients, non-operative treatment should be contemplated. The main disadvantage of non-operative treatment is that the recovery is probably slower. On average, the main checkpoints of recovery occur 3-4 weeks quicker with operative treatment than with non-operative treatment. In addition, the re-rupture rate appears to be higher with some non-operative treatments. Re-rupture typically occurs 8-18 months after the original injury. Achilles tendon

Surgical Treatment
Surgery offers important potential benefits. Besides decreasing the likelihood of re-rupturing the Achilles tendon, surgery often increases the patient?s push-off strength and improves muscle function and movement of the ankle. Various surgical techniques are available to repair the rupture. The surgeon will select the procedure best suited to the patient. Following surgery, the foot and ankle are initially immobilized in a cast or walking boot. The surgeon will determine when the patient can begin weightbearing. Complications such as incision-healing difficulties, re-rupture of the tendon, or nerve pain can arise after surgery. Whether an Achilles tendon rupture is treated surgically or non-surgically, physical therapy is an important component of the healing process. Physical therapy involves exercises that strengthen the muscles and improve the range of motion of the foot and ankle.

Prevention
Good flexibility of the calf muscles plays an essential role in the prevention of Achilles tendon injuries. It is also important to include balance and stability work as part of the training programme. This should include work for the deep-seated abdominal muscles and for the muscles that control the hip. This might at first appear odd, given the fact that the Achilles are a good distance from these areas, but developing strength and control in this area (core stability) can boost control at the knee and ankle joints. Training errors should be avoided. The volume, intensity and frequency of training should be monitored carefully, and gradually progressed, particularly when introducing new modes of training to the programme. Abrupt changes in training load are the primary cause of Achilles tendinopathy.

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