Achilles tendon injuries: the potential life-long consequences associated with delayed diagnosis and treatment

Posted: 22/03/2021

Achilles tendon ruptures are reported to be the most common tendon ruptures in the lower extremity, and occur most frequently in adults between the ages of 30 and 50 years. It is estimated that they will affect one in every 15,000 people at any time, becoming more prevalent in competitive athletes, with occurrences increasing to one in every 8,000.

Among the general public those at greatest risk of Achilles tendon injuries are only active intermittently, typically those who partake in sports mainly at weekends, thus being labelled ‘weekend warriors’ amongst health professionals and academics.

The causes of Achilles tendon ruptures typically include sudden forced plantar flexion of the foot or direct trauma to the back of the ankle/calf, as this is when the ankle is subject to extreme pronation causing significant stress on the tendon, thus resulting in injury. The sports that are often associated with injuries of this nature include tennis, squash, netball, basketball and track.

It is important to seek urgent medical advice if you have the symptoms of an Achilles tendon rupture, and, likewise, the attending medical professional should elicit an appropriate history and perform a detailed physical examination so as to ensure a prompt diagnosis can be given. The value of early diagnosis and treatment is illustrated in a case in which Penningtons Manches Cooper’s clinical negligence team is currently acting for a young woman who ruptured her Achilles tendon during an exercise class but was only diagnosed some 11 weeks after sustaining the injury.

The importance of rehabilitation following diagnosis and treatment

In addition to the need for early diagnosis and treatment, patients should be aware of the requirement that appropriate measures for rehabilitation are implemented as soon as possible after removal of the plaster cast which is used for both non-surgical and surgical modes of treatment.

Typically, patients will be referred for physiotherapy where they will undergo gentle strengthening and balancing exercises to aid their recovery. With early/prompt diagnosis and treatment and appropriate rehabilitation, a very good recovery is to be expected. A 95% return in the function of the tendon, in comparison with its pre-injury function, can be anticipated. Unfortunately, in cases involving delayed presentations and treatment for Achilles tendon injuries, the outcome in terms of the return of the function is likely to be significantly less. This can result in residual symptoms of discomfort which can often be exacerbated in different weather conditions, and problems with balance, altered gait, poor strength of the affected leg resulting in over-compensating with the uninjured leg, and issues with mobility.

Naomi Holland, a senior associate in the clinical negligence team, comments: “Unfortunately, we have represented several clients who have had the misfortune of experiencing avoidable prolonged delays in the diagnosis and treatment of Achilles tendon ruptures, and as a consequence, have suffered a poor outcome with life-long implications. If liability can be established in a legal case, then as part of our investigations, we will assess their rehabilitation needs to optimise their prospects of achieving the best recovery possible. As part of our investigations, we organise assessments with independent specialists in their respective fields of medicine, which can include specialist orthopaedic surgeons, physiotherapists, orthotics experts, and care experts, depending on the client’s individual situation. In addition to assessing rehabilitation needs, we will assess whether there are any adaptations required to their homes and what long-term provisions need putting in place after the case has settled.

“Many of our clients pursue a legal case to highlight the issues in their care, but it is equally important to ensure that they have the resources available to them to optimise their recovery. The implications of delayed diagnosis and treatment of Achilles tendon ruptures can be severe and far-reaching so it is crucial that rehabilitation needs are explored and access to those needs is facilitated.”  

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