Achilles Tendon Rupture - MRI
The Achilles tendon is one of the strongest tendons in the MRI`body, yet it is most commonly affected by spontaneous ruptures. Ruptures occur primarily in patients who participate in activities involving explosive acceleration and maximal effort. Untreated Achilles tendon ruptures hinder an active lifestyle and additionally have a detrimental effect on activities of daily living. Increased functional length of the tendon in untreated patients results in significant weakness and altered gait and is the underlying reason why operative fixation is considered for this pathology.
Most patients will feel a sudden sense of pain and loss of function of the leg when the tendon ruptures. Many patients describe a feeling as if they were hit in the back of the leg and heard a loud pop. This injury does not occur from direct contact, even though that is what many patients feel may have happened at the time of the injury. The tendon ruptures because it does not have the elasticity to tolerate the high stress that can occur with explosive activity. On examination, a defect is felt approximately 4-6 cm above the heel bone where the tendon has ruptured, and there is weakness with pushing the foot down (plantar flexion). Additionally, there is more “up motion” of the ankle (dorsiflexion) when compared to the uninjured side. There is data to demonstrate that when a patient has these findings that the diagnosis is an Achilles tendon rupture and no MRI is needed to further confirm the diagnosis. Xrays are obtained to ensure that the tendon has not pulled off the heel bone, as this type of rupture may require a different type of surgery compared to a non-insertional (more common) Achilles rupture. If there is any concern or non-surgical management is being considered then a MRI or Ultrasound may be ordered.
Modern treatment options for an acute Achilles tendon rupture include conservative care (functional rehabilitation) and open, percutaneous, and minimally invasive or limited open Achilles repair for acute midsubstance Achilles tendon ruptures. Individual patients have different functional needs of their lower extremity depending on age, occupation, and/or activity level. Choice of treatment regimen ultimately is up to the patient; the job of surgeons is to educate patients with current evidence based results. Outcomes also differ depending on patient compliance with treatment regimen. The debate is not as simplistic as whether surgery or conservative treatment is the best for an Achilles rupture; the real question is which treatment is best for a patient’s physiology and athletic demands. We individualize the appropriate treatment based on the needs of the patient and how long it has been from the injury before seeking treatment. As in cases where it has been more than 5 days from injury, conservative care may not be very effective as the tendon has already begun to heal in these cases. We use the advanced techniques of minimally invasive repair with the PARS device or mid-substance Achilles speed bridge to restore the appropriate tension of tendon to provide the maximal functional outcome and minimize the risk of infection.
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Our Published Literature Related to Achilles Ruptures
1. Minimally Invasive Treatments Of Acute Achilles Tendon Ruptures. Foot & Ankle Clinics. (2019)
2. Percutaneous Treatment Of Achilles Tendon Rupture: A Patient Reported Outcome Study. Foot & Ankle Orthopaedics. (2019)
3. Disorders Of The Achilles Tendon. Reconstructive Foot & Ankle Surgery: Management Of Complications. (2019) - Book Chapter
4. Achilles Tendinopathy. Foot & Ankle Surgery. (2019)
5. Flexor Hallucis Longus Tendon Transfer For Achilles Reconstruction. Foot & Ankle Surgery: Tricks Of The Trade. (2018) - Book Chapter
6. Disorders Of The Foot & Ankle. Miller’s Review Of Orthopaedics. (2019) - Book Chapter
7. Overview Of The Ankle & Foot. Essential Orthopaedics. (2019) - Book Chapter
8. Leg, Ankle, & Foot Diagnosis & Decision-Making. DeLee & Drez’s Orthopaedic Sports Medicine. (2018) - Book Chapter
9. Imaging Of The Foot & Ankle. DeLee & Drez’s Orthopaedic Sports Medicine. (2018) - Book Chapter
10. Heel Pain & Plantar Fasciitis: Hindfoot Conditions. DeLee & Drez’s Orthopaedic Sports Medicine. (2018) - Book Chapter
11. A Biomechanical Comparison Of Limited Open Versus Krakow Repair For Achilles Tendon Rupture. Foot & Ankle Orthopedics. (2017)
12. Acute Achilles Tendon Ruptures: An Update On Treatment. Journal Of The American Academy Of Orthopaedic Surgeons. (2017)
13. Guest Editorial: Soft Tissue Reconstruction In The Foot & Ankle. Techniques In Foot & Ankle Surgery. (2017)
14. Sports Injuries In The Foot & Ankle. Clinics Of Sports Medicine. (2015)
15. General Principles. Passport For The Orthopedic Boards & FRCS Examination. (2015) - Book Chapter
16. Generalized Conditions. Passport For The Orthopedic Boards & FRCS Examination. (2015) - Book Chapter
17. Hindfoot. Passport For The Orthopedic Boards & FRCS Examination. (2015) - Book Chapter
18. Disorders Of The Foot & Ankle. Miller’s Review Of Orthopaedics. (2015) - Book Chapter
19. Achilles Tendon Disorders. Presentation, Imaging & Treatment Of Common Musculoskeletal Conditions. (2011) - Book Chapter
20. Calf Injuries. Presentation, Imaging & Treatment Of Common Musculoskeletal Conditions. (2011) - Book Chapter
21. Flexor Tendon Disorders. Presentation, Imaging & Treatment Of Common Musculoskeletal Conditions. (2011) - Book Chapter
22. The Plantar Fascia. Presentation, Imaging & Treatment Of Common Musculoskeletal Conditions. (2011) - Book Chapter
23. Introduction To Magnetic Resonance Imaging Of The Foot & Ankle. Presentation, Imaging & Treatment Of Common Musculoskeletal Conditions. (2011) - Book Chapter
24. The Foot & Ankle. Sports Medicine & Arthroscopy Review. (2010) - Book Chapter
25. Non-Surgical Management Of Achilles Ruptures. Foot & Ankle Clinics. (2009)
26. Rehabilitation After Acute Ruptures Of The Achilles Tendon. The Achilles Tendon: Treatment & Rehabilitation. (2009)
27. Supine Patient Positioning During Repair Of Achilles Tendon Rupture. Foot & Ankle International. (2009)
28. Overview Of The Ankle & Foot. Essential Orthopaedics. (2009) - Book Chapter
29. Rehabilitation After Acute Ruptures Of The Achilles Tendon. The Achilles Tendon. (2008) - Book Chapter
