What is a chronic rupture of the Achilles tendon?
When an Achilles tendon rupture is not diagnosed early, the stump of the Achilles tendon begins to separate (contract at both ends). It becomes more difficult to walk and move forward with the foot. However, there are other muscles in the leg that try to compensate for the lack of strength in the Achilles tendon, but these muscles are not sufficient to maintain muscle strength in the leg. As the other muscles in the leg take on the extra workload, the toe joint begins to bend and may become permanently deformed. Surgical treatment is ideal and should be performed as soon as possible after diagnosis in order to restore maximum strength before the tendon retraction becomes too short. The type of surgery performed depends on the degree of separation of the tendon stump. If the separation is minor, then the tendon stumps can be pulled together and sutured together, as we did with the acute rupture of the Achilles tendon. If the separation is more pronounced, then a tendon transposition (using the patient’s own adjacent tendon) must also be performed. The tendon transposition uses the tendon of the second strongest muscle in the leg after the gastrocnemius, which is attached to the big toe (flexor hallucis longus). The transposition does not interfere with the movement of the big toe.
General rehabilitation
1.Patients will need to use crutches for 2-3 weeks after surgery.
2.After 2 weeks, the patient will begin walking in a removable boot.
3.During the rehabilitation period, there is no need to use a cast.
4.The boot has a hinge that allows the affected foot to move downward (plantarflexion), but it will limit the upward movement of the affected foot (dorsiflexion).
5.It is very important to walk and exercise under the guidance of the doctor after the surgery.
6.After reconstruction, the leg strength is good, but unfortunately it will not return to normal level.
7, Patients need to regain leg strength through physical therapy and hard exercises.
Special post-operative rehabilitation process
Day 1.
1.Put a plaster bandage on the affected foot to prevent the ankle joint from moving.
2.Cold compress, elevation of the affected foot and pain medication.
3.The leg may be numb for 4-12 hours, then there will be pain and possible blood leakage.
4, Do not drop the affected foot.
Day 14.
1.The first follow-up consultation is performed in the outpatient clinic, dressing is changed and the wound is examined.
2.Put on a boot for the affected foot, in which the affected foot is in a mild horseshoe foot position, and the affected foot can perform plantarflexion (downward movement of the foot). The upward movement of the ankle will be obstructed.
3.The patient can start to bear full weight while wearing the boot.
Weeks 3-6.
1.After 6 weeks, the boot is adjusted to a neutral position and physical therapy begins, and the patient can ride a bicycle without wearing the boot.
2. Perform more vigorous exercises under the guidance of a physical therapist.
Week 8.
The boot can be removed and physical therapy and rehabilitation exercises continue for 2 months.