Lateral or outside ankle ligament and Achilles tendon tears are relatively common sports injuries and sometimes require surgical treatment. The Achilles tendon is an extensive fibrous tissue cord situated in the lower leg, which attaches the calf muscles to the heel. A ruptured Achilles tendon occurs from tendon degeneration or a sudden stretch. Signs of a torn Achilles tendon include pain and a swollen heel. As a result, the foot will not be able to flex downward. The Achilles tendon is also prone to degeneration due to repetitive stress. Tendinitis, an inflammatory condition, arises from a slow decline in the tendon causing pain. However, the only difference between tendinitis and a torn Achilles tendon is the treatment used to resolve the condition. Typically, with tendinitis, I recommend non-surgical treatment such as anti-inflammatories, corticosteroids and physiotherapy, and a heel raise insert into a shoe.
In the case of an Achilles tendon rupture or tear, surgery will be considered after evaluation of the patient’s medical condition and requirements for work and sport. Torn ligaments in the ankle occasionally require repair or reconstruction using a tendon or synthetic graft. The Bostrom procedure is a day surgery so patients can go home after ligament repair.
Recurrent injury or sprain occasionally requires surgical repair.
Achilles tendon repair is done through a small incision. Minimally invasive surgery for Achilles tears is the preferred technique in my practice.
A series of imaging tests (MRIs, ultrasounds and x-rays) can be done postoperatively to evaluate the tendon or ankle ligament condition. The healing process will naturally speed up by a rehabilitation protocol once all skin incisions are healed.
Immobilising the leg is important in repairing a ruptured Achilles tendon. While the lower leg and ankle are immobilised, the ends of the tendon naturally attach. This technique has a slightly higher re-rapture rate than surgical repair.
After a certain time, approximately 2-months, primary repair is difficult. Weakness and pain can follow an untreated Achilles tear.
Yes, the healing has scar tissue. This might cause a slight thickening in the Achilles.
The aim is for the calf power to return to a tear to the uninjured side as possible.
Johannesburg Surgical Hospital, 219 Beyers Naude Drive,
Northcliff
Randburg
2195
