The course of the Achilles tendon tear is mainly influenced by the chosen treatment method. Surgical treatment methods can more often be accompanied by wound healing disorders and infections in the surgical area. With intensive therapy combined with physiotherapeutic training, the original mobility and performance capacity of the tendon can be regained in most cases.
Furthermore, it is decisive whether the tendon is completely torn or only torn. If it is completely torn, a distinction can be made as to whether it has torn off together with a piece of bone or not. Since the type of Achilles tendon damage also determines the therapy, this factor is decisive for the course and prognosis of the disease.
Especially for top athletes, full performance can often no longer be achieved because the tendon cannot return to its original state 100%. At least some residual scar tissue remains, which can already reduce the performance level in high-performance sports. It is important that the Achilles tendon tear is detected early and treated accordingly. Otherwise it can lead to permanent functional impairment with a decline in calf muscles. The same applies to failed operations or other unsuitable therapeutic measures.
Conservative therapy means that the Achilles tendon rupture is not treated surgically, but other methods are used to heal it. Conservative therapy measures are used particularly with only torn tendons, as well as with older patients, who will subsequently put less strain on the tendon. These measures mainly include a temporary immobilisation of the affected ankle in a special plaster cast or shoe.
These special shoes are equipped with a heel elevation which promotes the healing of the torn tendon. In addition, the patient can put weight on the foot again at an early stage thanks to the unyielding special shoe. After about 3 weeks, additional physiotherapeutic measures are usually initiated to promote and restore the mobility of the Achilles tendon including the lower leg and foot.
This therapy should be continued until the original functionality is regained. Surgical therapy must often be considered, especially for young people who want to do sports, and if there is a long distance between the ends of the torn Achilles tendon. The operation can be performed either under local or general anaesthesia.
The torn tendon is exposed during the operation and the free ends are reattached to each other with sutures. If the tendon has torn off together with a piece of the calcaneus, the torn off piece of bone is screwed back onto the calcaneus. Thus the tendon is simultaneously reattached.
If the tendon is severely worn and porous, it may be necessary to have a tendon plastic surgery. For this purpose, a piece of tendon is removed from the patient at another location, which then serves to bridge the damage to the Achilles tendon. The tendon of the musculus plantaris longus is often used for this purpose.
It does not perform any important function and is created in most patients. The advantage of the surgical therapy compared to conservative measures is that the Achilles tendon is more stable afterwards and a renewed rupture occurs significantly less frequently. Following surgical therapy, the foot must be immobilised for several weeks.
Afterwards, physiotherapeutic measures can be initiated to regain the functionality of the foot. If the Achilles tendon rupture is not treated, this can lead to severe loss of function. Within a few months, the ends of the tendon grow together again in a scar, but this leads to a significant lengthening of the tendon through the scar tissue.
This causes a functional restriction of the calf muscle, as it cannot develop the optimal strength due to the lengthened tendon. Affected patients suffer from a lack of strength in the ankle joint. In this case, even intensive training measures cannot restore full functionality. A comparable symptom pattern can develop if therapy measures fail. Therefore, an experienced doctor should be consulted for therapy of the Achilles tendon rupture.