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A partial or total rupture or tear of the Achilles tendon is a more serious condition than the more common Achilles tendinitis and requires immediate immobilization and, in severe cases, possibly surgery. Non-surgical Achilles tendon rupture treatments are often considered for patients who have wound-healing issues because of systemic illnesses such as diabetes or vascular disease. Elderly and inactive patients are also recommended to opt for non-surgical treatments.
Wearing a short leg cast is one option for non-surgical Achilles tendon rupture treatments. The cast is worn on the injured leg so the ankle is positioned with a small plantar flexion — slightly flexed away from the body at more than the usual 90 degree angle. The foot is immobilized in this position so the tendons remain in the optimal position for healing. The cast usually remains in position for six to 10 weeks, depending on the progress of the healing process.
The ankle may be gradually moved into a more neutral position toward the body after four to six weeks of immobilization. The immobilization will continue after the repositioning, though walking while wearing the cast is usually permitted at this point. Once a health professional determines the cast can be removed, a small heel lift is worn in the shoe for two to four months. It is at this point that a rehabilitation and physical therapy program commences to help the patient regain strength, flexibility and mobility.
Non-surgical Achilles tendon rupture treatments offer no wound complications, such as infection, scars and tissue breakdown. There is no exposure to anesthesia, which means there is no risk of adverse reactions and a much lower morbidity rate. The dangers posed by non-surgical treatments include a significantly higher risk of a rerupture, or the injury recurring. A rerupture would likely require complex surgery. The nature of the injury means non-surgical treatment may result in permanent loss of mobility, flexibility and strength, and also requires a greater length of time with the leg immobilized.
Open surgical repair is the most common of the Achilles tendon rupture treatments for people with limited or no additional health complications and for active people who wish to return to activity after healing. During surgery, incisions are made into the ankle to expose the site of the rupture while avoiding any damage to the sural nerve. Once the ends of the rupture or tear are located, they are cleaned and prepared for reattachment. The ends of the tear are repositioned and sutured back together with strong non-absorbable sutures, and care must be taken not to over- or under-tighten the tendon and the sutures.
After surgery, an immobilization cast or rigid orthosis is applied. An orthosis is an externally applied rigid brace. After a short immobilization period, the foot is repositioned and again immobilized. Partial weight bearing is permitted at this point. Immobilization commonly lasts from four to six weeks, after which rehabilitation begins to restore strength, flexibility and mobility. Full activity is commonly restored in as little as four months.
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