The Achilles tendon is the largest and most robust tendon in the human body.
Repetitive stress in athletes or simple aging in inactive people can lead to variations in this tendon’s structure. This can lead to partial or even complete tears of the tendon itself.
This injury often results from unrecognised or misunderstood chronic tendonitis. It mostly affects jumpers, runners, footballers and tennis players. It is believed to be the result of an abrupt contraction.
Typically, the athlete reports a sharp and sudden pain in the posterior region of the leg, often associated with a loud “crack" sound. Patients often report the sensation of having received a whip or kick from an opponent. The rupture generates an immediate functional impairment, preventing any kind of ambulation.
Diagnosis is mainly based on the clinical presentation: sometimes there is a gap evident at the break. The suspected diagnosis is often confirmed by an ultrasound that clearly shows the disruption of tendon fibres and allows us to distinguish between total and partial ruptures.
Surgical intervention is always required in these cases.
Numerous types of suture of the Achilles tendon can be performed. They are usually referred to as tenorraphies and nowadays these are performed thanks to techniques that imply only very small incisions, avoiding problems related to difficulties in cicatrisation of long incisions and, at the same time, reducing the times of recovery.
The intervention is usually followed by the immobilisation of the foot with a brace in equinism for 2 or 3 weeks and with a brace in a neutral flexion for 4 weeks, allowing a load only after the fourth week after surgery.
The rehabilitation therapies generally start the fourth or fifth week from surgery and, at the beginning, they are performed alternating pool and gym.
The patient who underwent total rupture of the Achilles tendon usually comes in Isokinetic with a brace locked in equinus at 20 ° after thirty days. After the first month you can make a medical examination and start the rehabilitation program.
The first objective is to reduce the inflammation and pain with draining massage therapy, immersion ultrasound, laser and gradually recover the motion and the correct pattern of walking: for the next month the load is permitted but only with tutor type named walker. At this stage are useful exercises in the pool, and active and passive mobilization of the posterior chain stretching to allow a more rapid recovery of mobility and a more secure recovery of gait pattern.
Once the surgeon allows the full load you can proceed to the therapeutic program in the gym with concentric and eccentric strengthening exercises, progressive twins, soleus, tibial, peroneal, intrinsic foot, quadriceps; both with free body exercises and with with tools, aerobic exercises on a bike, elliptical, treadmill, for the metabolic recovery. It is the longest phase and it is important to manage well the periods of loading and unloading, of strength, to allow to perform an isokinetic test with a difference in strength between the two limbs minor than 20%.
Passed the test the ultimate goal is the recovery of the athletic gesture. You will carry out preparatory exercises to the recovery of straight running, cornering, jumps, routes and technical fundamentals of the sport. It is critical, before discharge, to have recovered 100% of the strength in isokinetic tests and have recovered the optimal metabolic activity measured with a threshold test.