The surgical treatment of Achilles tendon disorders is integral to the restoration and function of the lower extremity. Achilles tendon pathology is broken down into anatomic areas, insertional and midsubstance, mechanism and timing of injury, acute tears, and chronic pathology.
Acute ruptures of the Achilles tendon, in both elite athletes and “weekend warriors,” remain a common occurrence with an increased incidence in competitive athletes and elderly populations. Chronically attenuated ruptures can be challenging as the muscle undergoes fatty infiltration, thereby decreasing its ability to contract, and in the chronically torn tendon, it can be difficult to re-oppose the proximal and distal segments often times requiring indirect repair or tendon transfers.
Insertional Achilles pathology is a spectrum of problems from tendinitis to tendinosis. Tendinopathy refers to the triad of pain, swelling, and impaired function. Tendinosis occurs because of degenerative processes in the tendon that can be moderated by blood supply, mechanical demand, genetic predisposition, and training errors. The assessment of tendon integrity influences the treatment protocol with tendon transfers being recommend for tendon compromise of over 50%. If the tendon quality is poor, a flexor hallucis longus tendon transfer with or without reattachment of the residual tendon can be performed to restore functional plantar flexion strength.
This is a preview of subscription content, log in to check access.
Marican MM, Fook-Chong SM, Rikhraj IS. Incidence of postoperative wound infections after open tendo Achilles repairs. Singap Med J. 2015;56(10):549.CrossRefGoogle Scholar
Järvinen TA, Kannus P, Maffulli N, Khan KM. Achilles tendon disorders: etiology and epidemiology. Foot Ankle Clin. 2005;10(2):255–66.CrossRefGoogle Scholar
Khan RJ, Fick D, Keogh A, et al. Treatment of acute achilles tendon ruptures. A meta-analysis of randomized, controlled trials. J Bone Joint Surg Am. 2005;87:2202–10.CrossRefGoogle Scholar
Wong J, Barrass V, Maffulli N. Quantitative review of operative and nonoperative management of achilles tendon ruptures. Am J Sports Med. 2002;30:565–75.CrossRefGoogle Scholar
van der Linden PD, Sturkenboom MC, Herings RM, et al. Increased risk of achilles tendon rupture with quinolone antibacterial use, especially in elderly patients taking oral corticosteroids. Arch Intern Med. 2003;163:1801–7.CrossRefGoogle Scholar
Pajala A, Kangas J, Ohtonen P, Leppilahti J. Rerupture and deep infection following treatment of total Achilles tendon rupture. J Bone Joint Surg Am. 2002;84-A:2016–21.CrossRefGoogle Scholar
Highlander P, Greenhagen RM. Wound complications with posterior midline and posterior medial leg incisions: a systematic review. Foot Ankle Spec. 2011;4:361–9.CrossRefGoogle Scholar
Leppilahti J, Puranen J, Orava S. Incidence of Achilles tendon rupture. Acta Orthop Scand. 1996;67(3):277–9.CrossRefGoogle Scholar
Lantto I, Heikkinen J, Flinkkilä T, Ohtonen P, Leppilahti J. Epidemiology of Achilles tendon ruptures: increasing incidence over a 33-year period. Scand J Med Sci Sports. 2015;25(1):e133–8.CrossRefGoogle Scholar
Kedia M, Williams M, Jain L, Barron M, Bird N, Blackwell B, Richardson DR, Ishikawa S, Murphy GA. The effects of conventional physical therapy and eccentric strengthening for insertional Achilles tendinopathy. Int J Sports Phys Ther. 2014;9(4):488.PubMedPubMedCentralGoogle Scholar
Haglund P. Beitrag zur Klinik der Achillessehne. Zeitschri fu ̈r Orthopa ̈die und Unfallchirurgie. 1928;49:49–58.Google Scholar
Maffulli N, Ajis A. Management of chronic ruptures of the Achilles tendon. JBJS. 2008;90(6):1348–60.CrossRefGoogle Scholar
Nilsson-Helander K, Silbernagel KG, Thomeé R, Faxén E, Olsson N, Eriksson BI, Karlsson J. Acute Achilles tendon rupture: a randomized, controlled study comparing surgical and nonsurgical treatments using validated outcome measures. Am J Sports Med. 2010;38(11):2186–93.CrossRefGoogle Scholar
Pedowitz D, Beck D. Presentation, diagnosis, and nonsurgical treatment options of the anterior tibial tendon, posterior tibial tendon, peroneals, and Achilles. Foot Ankle Clin North Am. 2017;22:677–87.CrossRefGoogle Scholar
Steginsky B, Van Dyke B, Berlet G. The missed Achilles tear: now what? Foot Ankle Clin North Am. 2017;22:715–34.CrossRefGoogle Scholar
Labib SA, Rolf R, Dacus R, et al. The giftbox repair of the Achilles tendon: a modification of the Krackow technique. Foot Ankle Int. 2009;30(5):410–4.PubMedGoogle Scholar