PD Dr. med. Fabian Krause
Chief Physician Foot and Ankle Surgery, Inselspital, University of Bern
Conservative and operative treatment of Achilles tendon ruptures
Depending on the patient's age, athletic demands and position of the tendon stumps in the ultrasound, the torn tendon is either surgically treated by tendon suture or treated purely conservatively.
In case of surgery, the sewn sinews should not come under excessive tension, and all optimal conditions for the delicate wound healing must be met. The foot is therefore set in a cast for the first two weeks elevated in a club foot position. Pain, swelling and bleeding are thus reduced. After about 1-3 days, the voluminous dressing is removed and replaced with a plastic cast. Two weeks after surgery, the wound is checked. If it is sufficiently healed, care continues as with conservative therapy.
The patient is supplied in the acute phase with soft plastic gypsum cast. The cast is worn for 6 weeks and changed every 2 weeks. In the first period after the accident, the foot needs to be elevated often. Every patient receives from the beginning on a special shoe, the Künzli Ortho Rehab Total, which, according to the symptoms, can allow the foot to be fully weighted. Each Rehab Total comes with two different wedges to ensure the necessary foot position for rehabilitation. Six weeks after the start of therapy, the last cast is removed and the wedges are successively reduced over a further 6 weeks. The shoes, as well as the wedges, are always worn on both sides. As a result, the gait pattern is symmetrical, and a hip obliquity is avoided.
The wearing of the Künzli shoe allows the patient to quickly put full weight on the foot and achieve natural use of joints and muscles. The patient stays mobile thanks to the pair of shoes and can perform everyday movements after a few weeks.