Performed by – David Hinsley, Ngwe Phyo, Nick Ward

The Achilles tendon is a strong cord that attaches the calf muscles to the heel bone. It is used to push off with the foot when walking and running. Rupture of the Achilles tends to occur during sporting activity. The patient will often describe hearing a crack or feeling like they have taken a blow to the back of the heel. There is often marked discomfort and the patient struggles to walk.

Many patients have had previous problems with aching around the Achilles tendon due to degenerative changes within the tendon. These changes occur from the late thirties onwards. Ruptures classically occur in patients in their late thirties and forties as they remain physically fit and pursue high impact sports such as squash but have achilles tendonopathy.

Initial treatment involves icing the area and putting a half plaster cast on that keeps the toes pointed like a ballerina. The patient will need crutches and should not bear any weight on the affected foot. The next step is examination by an orthopaedic surgeon with a special interest in foot and ankle surgery and then an ultrasound examination will be performed to determine how close the two ends of tendon are. If they are less than 5mm apart then this means surgery is often not required unless the patient is an elite athlete.

If the ends are 5mm or more apart then surgery should be considered as the re-rupture rate is deemed to be higher if the foot is treated with plaster casts alone. Whether surgery is used or not does not change the length of time that the foot needs to be immobilized in plaster which will be seven weeks in total. Initially the foot will be fully pointed and the last plaster cast (there will be a minimum of three used to gradually bring the foot up to a neutral position) with the foot at right angles to the leg.

On removing the plaster cast, heel raises will be inserted into the patients shoes in order to offload the Achilles and physiotherapy will be started.