Chronic Achilles Tendon Rupture
Neglected or Chronic Achilles tendon rupture
Ongoing weakness in walking and pain in the calf following a known episode of acute rupture of Achilles tendon is defined as chronic Achilles tendon rupture. This may be because of non-healing or incomplete healing of acute rupture of Achilles tendon.
Other muscles in the leg that try to compensate for the loss of strength in the Achilles and the leg muscle (the gastrocnemius) but these are never sufficient to maintain the power and strength of the leg. Usually therefore weakness occurs, and the patient will find it difficult to push off when walking and in particular going up and down stairs. As the process evolves, the toe muscles have to work extra hard, and due to the extra workload on these muscles of the leg, the toes begin to curl and may even get permanently deformed.
Clinically patient will have pain and muscle atrophy in the calf. There may or may not be a palpable gap.
Ultrasound or MRI testing confirms the Diagnosis.
This condition is best treated by surgery. It cannot be cured by plaster or other treatments.
The type of surgery performed depends on the size of the gap between the tendon ends and the extent of separation that is present. If the separation is minimal, then the tendon ends can be stitched together much like what was described above for acute Achilles rupture. If the separation is more significant, then other procedures need to be performed. As the gap gets bigger, the options then range from using a strip of the lining of the existing Achilles (called a V-Y advancement) or using one of your other foot tendon as a tendon transfer, or even using an Achilles tendon graft which comes from the tissue bank.
In Indian conditions transfer of another tendon of your foot is a safe, effective and economical option. Dr Bhargava prefers to use the second strongest muscle in the leg, the muscle to the big toe (the flexor hallucis longus).
This operation is usually very successful. After the operation patients are able to regain push off comfortably. Their pain and weakness improves and they can even participate in some sporting activities. This operation can be performed through a very small incision on the back of the ankle. Sometimes I like to make a make a second cut in the arch of the foot to retrieve the tendon for the transfer.