SmartHallux® Method
Smarthallux explains to you
All you need to know
on the Achilles tendon
What does Achilles tendon rupture mean?
An Achilles tendon rupture is the most common tendon rupture in the lower extremity. The injury most commonly occurs in adults between the third and fifth decades of life.
It is a very common event, with an incidence ranging between 18 and 40 cases per 100000 inhabitants each year.
Approximately 10% of patients report having symptoms before the injury, particularly pain in the region of the Achilles tendon 3 to 6 cm above its insertion on the heel.
Achilles tendon rupture is a common injury among athletes, but it can also affect non-athletes. Surgery is often necessary to reconstruct the Achilles tendon and restore ankle function.
Why does the Achilles tendon rupture?
There are certain factors that increase the likelihood of an Achilles tendon rupture, particularly intratendinous degeneration (tendinosis), the use of certain antibiotics, corticosteroid injections, prolonged use of oral corticosteroids, oral bisphosphonates, diabetes, hyperthyroidism, and genetic factors. Overexertion can also increase the risk of rupture, especially in people who participate in sports that require sudden bursts of speed and/or changes of direction.
When the Achilles tendon ruptures, the proximal "stump," the one connected to the triceps surae muscle, tends to rise due to the muscle's action. The greater the distance between the two stumps, the greater the tension at the suture level, resulting in a slower and sometimes incomplete recovery. Tenorrhaphy, or suturing of the Achilles tendon, aims to re-establish the tendon's continuity.
Achilles tendon rupture: surgical techniques
In the most severe cases, where the distance between the two ends of the tendon is excessive, the tendon of the flexor hallucis longus will be used to strengthen the Achilles tendon, with a minimally invasive, reproducible, and rapid recovery procedure, without losing the flexion of the big toe.
There are several surgical techniques for repairing the Achilles tendon. The choice of technique depends on several factors, including the patient's age, level of physical activity, and the severity of the tear. The most common techniques are:
• Open repair: This technique involves making an incision in the skin to expose the ruptured tendon. The surgeon then stitches the two ends of the tendon back together.
• Percutaneous repair: This technique involves inserting a needle through the skin with special instruments to reach the ruptured tendon and stitch the tendon back together.
• Minimally invasive technique: This technique involves the use of small incisions in the skin to access the ruptured tendon and special instruments to repair the tendon.
Why choose SmartHallux?
At SmartHallux, we use a cutting-edge, minimally invasive technique that, through a small incision at the tendon rupture site, allows us to reconstruct it and "anchor" it to the heel. This avoids the presence of knots at the rupture point, which can weaken the reconstruction and cause discomfort related to the stitches in an area sparsely covered by fat.
You'll have a number you can call 24/7. Email us and we'll get back to you as soon as possible for a telemedicine consultation. We'll provide a diagnosis and arrange your hospitalization and any necessary tests at our top-notch facilities in Rome, Milan, and Naples.
Achilles tendon rupture: diagnosis
Acute ruptures often present a sudden onset of pain associated with an audible "snap" or "pop." Patients may describe a sensation similar to that of being hit in the leg—just look at David Beckham during a match for AC Milan.
On examination, patients with a ruptured Achilles tendon are unable to stand on tiptoe or even unable to plantar flex their ankle. Palpation may reveal a discontinuity in the tendon.
The Thompson test is performed to assess the continuity of the Achilles tendon. The patient is positioned prone; by squeezing the calf, the examiner observes the presence and degree of plantar flexion of the foot and ankle, comparing it to the other side. An absence of plantar flexion is highly indicative of a tendon rupture.
Magnetic resonance imaging (MRI) or, if it is not possible to perform it quickly, an ultrasound are essential to evaluate the location of the lesion and the distance between the two ends of the tendon, which tends to increase over time if not treated early.
Achilles Tendon Rupture: Regenerative Medicine
Regenerative medicine is an innovative field in which therapies harness the body's self-healing abilities to heal injuries. For the Achilles tendon, regenerative medicine approaches may include the use of stem cells and growth factors such as PRP and adipose-derived mesenchymal stem cells to stimulate healing and regeneration of damaged tissue.
It can be used in combination with other techniques for the prevention of Achilles tendon rupture, if there is non-insertional Achilles tendinopathy (link to article), or after tendon rupture (together with reconstruction) to improve and speed up healing.
Achilles tendon rupture: treatment
Treatment of Achilles tendon rupture can be surgical or non-surgical.
The choice of treatment varies based on the patient's functional needs, age, and any contraindications to surgery. It is widely demonstrated that surgery provides better results than conservative treatment, allows for a much faster recovery, and significantly reduces the risk of re-rupture of the tendon.
In the past, surgery was fraught with complications, particularly problems related to wound healing, the risk of infection, and the adhesions that form when performing an open procedure.
Advances in techniques and materials now allow for minimally invasive percutaneous interventions, avoiding large incisions and using the most advanced techniques and stem cells to make recovery faster, safer, and less complicated.
Our surgical techniques
Surgical techniques have undergone an important evolution compared to the past, starting from anesthesia and post-operative pain control.
The goal of SmartHallux
SmartHallux's goal is to revolutionize the treatment of Achilles tendon ruptures and all foot and ankle conditions. To achieve this goal, we employ the best minimally invasive surgical techniques, orthopedic devices, instruments, and materials available on the market.
This is why we propose ourselves as private healthcare at an accessible and financeable cost. Unfortunately, public and subsidized healthcare have spending limits that place limits on the use of materials, instruments and structures.
With SmartHallux you will have access to the best possible treatments, in excellent facilities and without having to wait for public health authorities.
Anesthesia
The anesthesia that we use at SmartHallux does not involve painful ankle punctures or annoying spinal anesthesia or general anesthesia. With ultrasound guidance, our anesthetists are able to identify the nerves and with a single puncture behind the knee they are able to selectively "put to sleep" the nervous structures necessary and sufficient to perform the operation without pain, leaving the mobility of the legs and bladder control to the patient.
Sedation allows the patient not to feel anxiety and, often, to wake up directly at the end of the surgery.
This type of anesthesia also allows for anesthesia to be prolonged for up to 24-48 hours, reducing or even eliminating post-operative pain, without any risks or contraindications.
Only in cases where it is necessary to harvest stem cells from abdominal fat is spinal anesthesia associated.
Duration of the intervention
The procedure lasts approximately 40-50 minutes. The patient enters the hospital in the morning and returns home the same evening or the day after surgery.
Achilles tendon rupture: recovery time
After Achilles tendon surgery, it is important to follow a rehabilitation program to help the tendon heal and regain function.
Immediately after surgery, a fiberglass cast or brace is placed, as needed, for 4 weeks.
The day after surgery, when sensation is fully recovered, the patient can walk, placing approximately 20-30% of their weight on the operated foot, using two crutches.
The first check-up is performed approximately 15 days after surgery to assess the condition of the wounds. The absorbable stitches fall out on their own. Full weight-bearing can be permitted after 4-6 weeks.
Complete recovery generally occurs 2-3 months after surgery, although the regeneration process can take up to 12 months. Patients can return to contact sports after 6-8 months.
Risks and complications associated with surgery are very rare, especially with non-invasive surgery. They include bleeding, allergic reactions, infections, deep vein thrombosis, embolisms, and skin complications, nerve damage with loss of sensation, persistent pain at the scar, delayed union, pseudoarthrosis, and joint stiffness.
The use of antibiotics and low molecular weight heparin and the use of percutaneous techniques further reduce the risk of complications.
Achilles tendon rupture: Prevention
Preventing Achilles tendon injuries remains our best weapon at our disposal.
Gradually increase the intensity and duration of your workout, avoiding sudden increases in activity.
Tones the calf muscles and Achilles tendon.
Use well-cushioned shoes that are suitable for the activity you are practicing.
Perform stretching exercises regularly to improve the elasticity of your tendons and muscles.
Avoid excessive training loads and overexertion, especially without proper preparation. Respecting rest and recovery periods after intense physical activity gives your body time to regenerate.
Achilles tendon rupture is a common occurrence that can now be treated and even prevented, thanks in part to the use of stem cells.
Modern treatment options, including regenerative medicine, minimally invasive surgeries, and early recovery, offer real hope for a faster recovery and a return to active life.
SmartHallux offers an emergency service for Achilles tendon rupture.
This service includes:
• Immediate patient assessment
• Temporary immobilization pending surgery
Intervention within 36 hours of the breakage
• Personalized rehabilitation plan
Why choose SmartHallux for surgery?
Our doctors, led by Dr. Manzi, have extensive experience treating Achilles tendon ruptures and have a very high patient satisfaction rate.
The secrets of our success lie in the use of the best surgical and anesthesiological techniques, and the use of cutting-edge, top-quality materials.
Waiting times for Achilles tendon rupture surgery on the National Health Service (NHS) can be very long, varying from region to region and from facility to facility. SmartHallux offers the possibility of accessing surgery more quickly, avoiding long waiting lists, with a dedicated emergency room for patients suffering this injury and a revolutionary, minimally invasive technique using stem cells, unlike what can be achieved with the National Health Service (NHS).
SmartHallux® Certified Clinics
FAQ
Typically, the average cost for an Achilles tendon repair is around €12-15.000. At SmartHallux, thanks to the advanced technique used and our collaboration with several clinics, you can get a significantly more competitive price.
Dr. Manzi visits medical practices that collaborate with SmartHallux located in Rome, Milan, and Naples.
It is also possible to book a telemedicine visit.
