Achilles Tendon Ruptures

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

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 incisionhealing

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.