Achilles Tendon Rupture Treatment in Los Angeles
An Achilles rupture is often misdiagnosed as an ankle sprain, and delays in treatment are unfortunate but common. Dr. Alexis Dixon, MD, FAAOS, a board-certified orthopaedic foot & ankle surgeon in Marina del Rey, diagnoses and treats Achilles tendon ruptures.
Foot & Ankle Conditions
What Is an Achilles Tendon Rupture?
A rupture is a partial or complete tear of the Achilles tendon. The Achilles tendon is the largest tendon in the body. It allows you the strength to push off with up to ten times body weight in force. Unfortunately, at these extremes, sometimes the tendon ruptures. The Achilles tendon very rarely partially ruptures.
Patients complain of a popping sensation, like they were hit in the back of the heel with significant force. These can often be misdiagnosed as ankle sprains, and delays in treatment are unfortunate but common. A rupture is time-sensitive: the sooner it is diagnosed, the more treatment options you have. If you suspect a torn Achilles, seek evaluation right away.
Get an Accurate Diagnosis
Diagnosis
An Achilles rupture is usually obvious to a trained specialist based on history and physical examination alone. X-rays are still obtained to rule out any fracture. An MRI is often performed to assess the quality of the tendon and the amount of retraction.
Symptoms
Many people describe a sudden pop or a feeling of being kicked in the back of the ankle. Common symptoms include:
- A popping sensation, like being hit in the back of the heel with significant force
- Sharp pain and swelling
- Difficulty pushing off or rising onto the toes
- Mild Achilles pain or a tight calf leading up to the injury
What Causes It and Who Is at Risk
These injuries commonly occur in the male “weekend warrior,” such as 20 to 40 year olds who play intense sports like tennis or basketball without daily stretching or training. Other risk factors include:
- High arch
- Obesity
- Diabetes
- Rheumatoid arthritis
- Lack of stretching
- Anabolic steroid usage
- Certain antibiotics such as ciprofloxacin and Levaquin
Often, the Achilles is mildly painful, or the calf is tight leading up to the injury.
Conservative First, Surgical When Needed
Treatment Options
Immobilization and rest are the first steps.
Nonsurgical
Non-operative Treatment
Occasionally, an Achilles rupture treated within 24 to 48 hours can be treated non-operatively. This requires a cast with the toes pointed downwards to allow the tendon ends to heal. However, this treatment results in about a 10% re-rupture rate and must be monitored with MRI.
Surgical Repair
More commonly, there is hematoma (pooled blood) and scar build-up at the site of the rupture that does not allow for non-operative treatment. In these cases, and for patients who want to minimize the risk of re-rupture and a much more extensive surgery, a surgical repair is indicated. In this surgery, the ends of the tendon are held together with strong suture, and the foot is immobilized in a cast, and weight-bearing is not allowed until the tendon has healed adequately to be strong enough to bear weight. For optimal results, surgery is performed within 7 to 10 days of the injury, but it can still be performed up to 6 weeks out. Beyond that point, a more complex reconstructive surgery may be necessary. Specifics regarding pre- and post-operative protocol are discussed in more detail if that is the appropriate option for you.
Nonsurgical
Ice and Anti-Inflammatories
To help to decrease the pain before and after surgery, ice and NSAIDs may be used. Ice should be placed with a tea towel protecting the skin for no more than 20 minutes per hour. Ice is not advised in patients with neuropathy or any numbness in the feet. Speak to your doctor if there is concern for contraindications to anti-inflammatories such as naproxen or ibuprofen.
Physical Therapy
After the tendon has been repaired, physical therapy is crucial to strengthen the muscles that have become weak and to improve balance after immobilization is complete. This will help to accelerate recovery once the tendon has healed. Running is not permitted until six months after repair, whether in a cast or in surgery.
Maximizing Healing Potential
A healthy diet, abstinence from any nicotine products, and appropriate vitamin supplementation are critical to supply the healing tendon with the nutrients and oxygen it needs to heal. If you are interested in an anti-inflammatory diet, you can request this information from Dr. Dixon’s assistant.
Why See a Board-Certified Orthopaedic Surgeon (MD)?
Achilles injuries, especially ruptures, are time-sensitive, and the choice between non-surgical and surgical treatment shapes your recovery and return to sport. A board-certified, fellowship-trained orthopaedic foot & ankle surgeon offers the full range of options and the surgical expertise if you need it. Foot and ankle orthopaedic surgeons complete medical school, five years of residency training in orthopaedic surgery, and a yearlong advanced fellowship focused on foot and ankle care. It is highly recommended to always consult with a foot and ankle orthopaedic surgeon before planning surgery in the region.
After Treatment
What Recovery Looks Like
Surgical recovery usually means six weeks in a cast with the toes pointed downwards, followed by 3 to 6 weeks in a boot, gradually working the foot to neutral. Physical therapy then strengthens the muscles that have become weak and improves balance after immobilization is complete. Running is not permitted until six months after repair. To prevent further injury or reinjury, it is best to wait until your balance and strength have been regained and improved. This requires specific balance training as well as core strengthening. Your physical therapist and physician will be able to tell you when it is safe for you to return to sports.
Weeks 1 to 6
About six weeks in a cast with the toes pointed downward while the repaired tendon heals.
Weeks 6 to 12
3 to 6 weeks in a boot, gradually working the foot back toward neutral.
After immobilization
Physical therapy rebuilds strength and balance.
6 months
Running is not permitted until six months after repair. Return to sport once balance and strength are regained.
What Patients Say
Patient Reviews
Patient Questions
Achilles Rupture FAQs
About Your Surgeon
Alexis E. Dixon, MD, FAAOS
Dr. Dixon is a board-certified orthopaedic foot & ankle surgeon practicing in Marina Del Rey, California. USC-trained and named an LA Magazine Top Doctor since 2017, she combines surgical expertise with a conservative-first philosophy, treating the underlying joint and tendon, not just the symptom. She treats ganglion cysts, bunions, Achilles injuries, plantar fasciitis, fractures, and the full range of foot and ankle conditions.
Meet Dr. Dixon →Think You Ruptured Your Achilles? Get Seen Right Away.
If you felt a pop in the back of your heel, get an accurate diagnosis and a clear plan from a board-certified orthopaedic foot & ankle surgeon in Marina del Rey.
Sources
References
The patient handout for this condition draws on the following sources.