Description

Achilles (uh-KILL-eez) tendon rupture is an injury that affects the back of the leg. It mainly occurs in people playing recreational sports, but it can happen to anyone.

The Achilles tendon is a strong fibrous cord that connects the muscles of the back of the calf to the heel bone. If it stretches too much of the Achilles tendon, it can tear (rupture) completely or just partially.

If your Achilles tendon ruptures, you might hear a pop, and immediately a sharp pain in the back of the ankle and the lower part of the leg that is likely to affect your ability to walk properly. The surgery is often performed to repair the rupture. To many people, however, nonsurgical treatment works just as well.

Symptoms

Although it is possible to have no signs or symptoms of an Achilles tendon rupture, the majority of people:

  • The feeling of having been kicked in the calf
  • Pain, possibly severe, and swelling near the heel
  • The inability to bend the foot downward or "push" the injured leg when walking
  • An inability to stand on your toes on the injured leg
  • A popping or snapping sound when the injury occurs

When to see your doctor

Seek medical attention right away if you hear a pop in the heel, especially if you can't walk very well after.

Causes

The Achilles tendon helps you point your foot downward, rise on your toes and push off with the foot when walking. You rely on it virtually every time that you walk and move your foot.

The rupture usually occurs in the section of the tendon located within 2 1/2 inches (about 6 centimeters) of the point where it connects to the heel bone. This section may be prone to rupture because the blood flow is poor, you can also impair your ability to heal.

Breaks are often caused by a sudden increase of tension in the Achilles tendon. Common examples include:

  • The increase of the intensity of sports participation, especially in sports that involve jumping
  • The fall from a height of
  • Enter a hole

Risk factors

Factors that may increase the risk of Achilles tendon rupture are:

  • Age. The peak age for Achilles tendon rupture is 30 to 40.
  • Sex. Achilles tendon rupture is up to five times more likely to occur in men than in women.
  • Recreational sports. Achilles tendon injuries occur more often in sports that involve running, jumping, and sudden starts and stops, such as football, basketball and tennis.
  • The steroid injections. Doctors sometimes inject steroids into the ankle joint to reduce pain and inflammation. However, this medication can weaken nearby tendons and has been associated with Achilles tendon ruptures.
  • Certain antibiotics. Fluoroquinolone antibiotics, such as ciprofloxacin (Cipro) or levofloxacin (Levaquin), may increase the risk of Achilles tendon rupture.
  • Obesity. Excess weight puts more pressure on the tendon.

Prevention

To reduce your chances of developing Achilles tendon problems, follow these tips:

  • Stretch and strengthen the muscles of the calf. Calf stretch until you feel a noticeable pull but not pain. Don't bounce during a stretch. Calf-strengthening exercises can also help the muscle and tendon absorb more force and prevent injury.
  • Vary the exercises. Alternative high-impact sports, such as running, with low-impact sports, such as walking, bicycling or swimming. Avoid activities that place excessive stress on your Achilles tendons, such as hill running and jumping activities.
  • Choose the management of the surfaces carefully. Avoid or limit running on hard or slippery surfaces. Dress appropriately for the cold weather of the training, and the wear and tear of fit of athletic shoes with proper cushioning in the heels.
  • Increase the intensity of the workout slowly. The achilles tendon injuries usually occur after a sudden increase in the intensity of the workout. Increase the distance, the duration and the frequency of your training by no more than 10 percent weekly.

Diagnosis

During the physical exam, your doctor will check your lower leg for tenderness and swelling. Your doctor may be able to feel a gap in your tendon if it has ruptured completely.

The doctor might ask you to kneel on a chair or lying on your stomach with your feet hanging over the end of the exam table. He or she can, then squeeze your calf muscle to see if your foot will automatically flex. If not, you probably have ruptured your Achilles tendon.

If there is a question about the extent of your injury, Achilles tendon — either completely or only partially broken — your doctor may order an ultrasound or an mri. These procedures are painless, to create images of the tissues of your body.

Treatment

The treatment for a ruptured Achilles tendon often depends on your age, activity level and the severity of your injury. In general, the younger and more active people, especially athletes, they tend to choose surgery to repair a completely ruptured Achilles tendon, while older people are more likely to opt for nonsurgical treatment.

However, recent studies have shown quite the same as the effectiveness of both surgical and non-surgical management.

The non-surgical treatment

This approach typically involves:

  • Rest of the tendon with the use of crutches
  • Apply ice to the area.
  • Taking over-the-counter pain relievers
  • Keep the ankle from moving during the first few weeks, usually with a walking boot with wedges or heel of a mold, with the foot flexed down

Non-surgical treatment avoids the risks associated with surgery, such as infection.

However, an approach to non-surgical can increase their chances of re-rupture and recovery may take more time, although recent studies indicate that favorable outcomes in people treated nonsurgically if you start rehabilitation with weight bearing early.

Surgery

The general procedure consists of making an incision in the back of the leg and stitching the torn tendon together. Depending on the condition of the rupture of the tissue, the repair may be reinforced with other tendons.

Complications may include infection and nerve damage. The minimally invasive procedures to reduce infection rates above those of open procedures.

Rehabilitation

After treatment, you will have physical therapy exercises to strengthen the muscles of the leg and the Achilles tendon. Most people return to their previous level of activity within four to six months. It is important to continue the strength and stability of the training after that due to some problems may persist for up to a year.

A type of rehabilitation is known as rehabilitation functional also focuses on the coordination of body parts and how they move. The purpose is to return you to your highest level of performance, as an athlete or in your daily life.

A review study concluded that if you have access to the functional rehabilitation, you can do just as well with the non-surgical treatment such as surgery. More studies are needed.

Rehabilitation after either surgical or non-surgical management is also a trend toward the former movement, and move forward faster. Studies are underway in this area also.

Preparing for your appointment

People with a rupture of the Achilles tendon commonly seek immediate treatment in a hospital emergency department. It may also be necessary to consult with medical doctors specializing in sports medicine or orthopedic surgery.

What you can do

Write a list that includes:

  • Detailed descriptions of the symptoms, and how and when the injury occurred
  • Information about the medical problems of the past
  • All of the medications and supplements you are taking, including dose
  • Questions to ask the doctor

What to expect from your doctor

The doctor may ask some of the following questions:

  • How did this injury occur?
  • Did you feel or hear a popping or clicking sound when it happened?
  • Can you stand tippy-toe on that foot?
Symptoms and treatment of Achilles tendon rupture