The large Achilles tendon is a strong, fibrous band that connects the calf muscle to the heel. Along with other tendons, it supports, stabilizes, and helps move the ankle. It is the most important tendon for walking, running, and jumping. It attaches the calf muscles to the calcaneus (heelbone) and allows us to point our toes or raise up on our toes.
In severe cases, the force of a violent strain can rupture the tendon. The classic example is a middle-aged tennis player or weekend warrior who places too much stress on the tendon and experiences a tearing of the tendon. In some instances, the rupture may be preceded by a period of tendonitis, which renders the tendon weaker than normal.
The decision about surgery may depend on your daughter-in-law’s past history and activity level. Does she have a prior history of sprains, strains, or even tears of that same muscle? Of course, standing and walking will be impaired but what was her activity level while off work and during leisure hours? These are factors to consider when making a decision like this.
The personal decision of work versus school is one that might get tipped by an incident like this. In either scenario, she is likely to be restricted in putting any weight on the injured leg. She will likely be using crutches or a little wheeled walker to support her lower leg (knee bent) while using the other leg to move around.
Sometimes young adults with an Achilles rupture are casted for a few weeks, then moved into an adjustable brace. The brace is worn by everyone for another six weeks or so. The position of the foot and ankle can be changed within the brace. The adjustment is made by a physical therapist every two weeks bringing the toes up and less pointed down. That’s what makes it an adjustable brace.
By the end of the six weeks period of time, the foot will be moved from the equinus position (toes down) past neutral (zero degrees of movement) and to a +10 degree position of ankle dorsiflexion (foot pulled up toward the face). At that point, patients often switch to a special shoe with a heel-lift. They can start putting some weight on the foot. It’s a slow but steady process.
There is one other thing to consider. It is clear that treatment with a cast will allow the vast majority of tendon ruptures to heal, but the incidence of rerupture is increased. Patients who are treated with casting for eight weeks compared with those undergoing surgery have a higher rate or reruptures. In addition, the strength of the healed tendon is significantly less in patients who choose cast treatment. For these reasons, many orthopedists feel that Achilles tendon ruptures in younger, active patients should be surgically repaired.