Achilles tendon rupture

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at April 26, 2016
StartDiseasesAchilles tendon rupture

The Achilles tendon is a strong cord-like structure connecting the back of the ankle bone to the muscles of the lower leg. A partial or complete tear through the tendon is known as an Achilles tendon rupture. Rupture of this commonly injured tendon is often a preventable injury.

Contents

Definition & Facts

A tendon is the body tissue structure that connects muscle to bone. When muscles contract, they cause bones to move. The Achilles tendon is one of the longest tendons in the human body. When the calf muscles contract in walking, running or jumping, this important tendon tightens and relaxes. The tightening and relaxing of the Achilles tendon makes the foot work, helping it to push-off and then land on a surface. If the tendon is over-tightened or jerked, it can tear partially or completely.

Symptoms & Complaints

The first sign of rupture is often hearing a pop or snap as the injury occurs. It is quickly accompanied by pain, which can be severe, above the back of the heel. This will be followed by swelling near the heel. The person who is injured finds it difficult or impossible to walk because the foot cannot push off.

It is also difficult or impossible to stand on the toes. The rupture may be seen as a depression at the back of the leg, several inches (about 6 cm) above the heel.

Causes

Achilles tendon rupture occurs when the tendon is stretched beyond its ability to hold together. Sudden and forceful jumping, turning on a dime or suddenly running can result in rupture. Athletes who are involved in gymnastics, football, running, baseball, softball, tennis or volleyball are candidates for this injury. People who are not active during the week and participate in weekend sports, gardening or other physical projects are susceptible as well.

Other causes of Achilles tendon rupture are: injury from stepping into a depression or hole, falling from a height, stumbling and falling on a flat surface or overuse of the tendon when it is already damaged from Achilles tendinitis (inflammation of the tendon).

The tendon can also become weak as a person ages and is less active, or from an illness such as diabetes or from certain medications such as injectable steroids and the antibiotics, ciprofloxacin or levofloxacin. An overlooked contributor to Achilles tendon rupture is the wearing of high heels. Over time, wearing high heeled shoes causes this tendon to shorten, making it more susceptible to a tear.

Diagnosis & Tests

A medical professional will examine the leg and conduct tests to determine a diagnosis. By examining the leg surface, the doctor may see and feel the gap where the tendon has torn. The doctor may also squeeze the calf muscle of the affected leg. If the Achilles tendon is ruptured, the toes will not point during the squeeze.

To clarify a diagnosis, an MRI or ultrasound may be ordered. Either an MRI or an ultrasound will give a clearer picture of the tendon and help the doctor determine if it has broken partially or completely. An X-ray is not usually taken as it does not clearly show non-bone tissue, also known as soft tissue, such as the Achilles tendon.

Treatment & Therapy

It is important to seek medical attention immediately because early treatment helps achieve better treatment results. Until medical attention can be obtained, take these measures: rest the injured area and apply ice over the injury; do not apply ice directly on top of skin; compress the injury to reduce swelling, taking care not to over-compress and cut off circulation; elevate the injured leg by placing pillows or rolled up blankets under it to also reduce swelling; if safe for the individual, an over-the-counter anti-inflammatory painkiller, such as ibuprofen, may ease discomfort.

There are both surgical and non-surgical treatments for this injury. Which one the physician chooses will depend on how severe the injury is along with activity level of the person. Surgical treatment will involve opening the back of the leg where the tear has occurred. The torn tendon ends will be stitched together. The usual surgical risks apply.

After surgery a special cast is worn for six to twelve weeks while the tendon heals. The non-surgical option will place the foot and lower leg in a cast, brace or boot with the toes down allowing the ruptured tendon time to heal on its own. If placed in a cast, the leg is recast periodically to reposition the toes.

All non-surgical treatments decrease the pull on the tendon and give it time to heal in a relaxed state. Both types of treatment have been shown to work; however, the re-rupture rate for non-surgical repair is higher than for surgical repair. Both treatment types, surgical and non-surgical, are followed by physical therapy to strengthen the muscles and recover the flexibility of the tendon. It takes around six months for full recovery regardless of the type of treatment that is chosen.

Prevention & Prophylaxis

The Achilles tendon rupture injury can be prevented with warm-up, stretching, and muscle strengthening. Getting ready to engage in strenuous sports or activities by performing joint and muscle warm-ups that include slow and gentle stretching of calf muscles can help prevent ruptures.

Performing regular exercises, like toe raises, to strengthen the calf muscles may also prevent ruptures. Additional preventative measures include stretching the Achilles tendon by doing things like pointing the toes toward the fronts of the legs after having warmed up the muscles.

If a person participates in high-impact activities such as running or jumping, he or she should alternate these with low-impact activities like swimming or walking. Training levels should be increased gradually over time so as not to over-work muscles and tendons suddenly. It is also important to avoid uneven or slippery surfaces where a fall could injure the Achilles tendon.

One should not ignore heat, swelling or pain in the back of the lower leg and ankle that could signal tendonitis or injury to the Achilles tendon. A medical professional can help track down what is causing it and recommend what to do to heal and avoid further complications.