Achilles Tendon Rupture
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What is the Achilles Tendon?
A tendon is a band of tissue that connects a muscle to a bone. The Achilles
tendon runs down the back of the lower leg and connects the calf muscle to the
heel bone. Also called the “heel cord,” the Achilles tendon
facilitates walking by helping to raise the heel off the ground.
What is an Achilles Tendon Rupture?
An Achilles tendon rupture is a complete or partial tear that occurs when the
tendon is stretched beyond its capacity. Forceful jumping or pivoting, or
sudden accelerations of running, can overstretch the tendon and cause a tear.
An injury to the tendon can also result from falling or tripping.
Achilles tendon ruptures are most often seen in
“weekend warriors” – typically, middle-aged people participating in
sports in their spare time. Less commonly, illness or medications, such as
steroids or certain antibiotics, may weaken the tendon and contribute to
ruptures.
Signs and
Symptoms
A person with a ruptured Achilles tendon may experience one or more of the
following:
- Sudden
pain (which feels like a kick or a stab) in the back of the ankle or calf
– often subsiding into a dull ache
- A
popping or snapping sensation
- Swelling
on the back of the leg between the heel and the calf
- Difficulty
walking (especially upstairs or uphill) and difficulty rising up on the
toes
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These
symptoms require prompt medical attention to prevent further damage. Until the
patient is able to see a doctor, the “R.I.C.E.” method should be
used. This involves:
- Rest. Stay
off the injured foot and ankle, since walking can cause pain or further
damage.
- Ice. Apply
a bag of ice covered with a thin towel to reduce swelling and pain. Do not
put ice directly against the skin.
- Compression. Wrap
the foot and ankle in an elastic bandage to prevent further swelling.
- Elevation. Keep
the leg elevated to reduce the swelling. It should be even with or
slightly above heart level.
Diagnosis
In diagnosing an Achilles tendon rupture, the foot and ankle surgeon will ask
questions about how and when the injury occurred and whether the patient has
previously injured the tendon or experienced similar symptoms. The surgeon will
examine the foot and ankle, feeling for a defect in the tendon that suggests a
tear. Range of motion and muscle strength will be evaluated and compared to the
uninjured foot and ankle. If the Achilles tendon is ruptured, the patient will
have less strength in pushing down (as on a gas pedal) and will have difficulty
rising on the toes.
The diagnosis of an Achilles tendon rupture is typically
straightforward and can be made through this type of examination. In some
cases, however, the surgeon may order an MRI or other advanced imaging tests.
Treatment
Treatment options for an Achilles tendon rupture include surgical and
non-surgical approaches. The decision of whether to proceed with surgery or
non-surgical treatment is based on the severity of the rupture and the
patient’s health status and activity level.
Non-Surgical
Treatment
Non-surgical treatment, which is generally associated with a higher rate of
re-rupture, is selected for minor ruptures, less active patients, and those
with medical conditions that prevent them from undergoing surgery. Non-surgical
treatment involves use of a cast, walking boot, or brace to restrict motion and
allow the torn tendon to heal.
Surgery
Surgery offers important potential benefits. Besides decreasing the
likelihood of re-rupturing the Achilles tendon, surgery often increases the
patient’s push-off strength and improves muscle function and movement of the
ankle.
Various surgical techniques are available to repair the
rupture. The surgeon will select the procedure best suited to the
patient.
Following surgery, the foot and ankle are initially
immobilized in a cast or walking boot. The surgeon will determine when the
patient can begin weightbearing.
Complications such as incision-healing difficulties,
re-rupture of the tendon, or nerve pain can arise after surgery.
Physical
Therapy
Whether an Achilles tendon rupture is treated surgically or non-surgically,
physical therapy is an important component of the healing process. Physical
therapy involves exercises that strengthen the muscles and improve the range of
motion of the foot and ankle
Information provided by The American College of Foot and Ankle Surgeons