The Achilles tendon, the largest tendon in the body, connects the calf muscle to your heel. The tendon can withstand significant stresses from running and jumping, but is vulnerable to injury. Achilles tendon ruptures are defined as a separation of the tendon off of the heel bone, or transverse tear of the tendon. When a rupture of the tendon occurs, the tendon is unable to perform normal function.
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Symptoms
Patients often describe a rupture of the Achilles tendon sounding like a “pop”, followed by an immediate sharp pain in the back of the ankle or lower leg. The ability to walk is immediately affected with the rupture. Swelling begins and is located mainly near the heel. The ability to “push off” of the injured leg or stand on tip toes is grossly affected by the injury. Your doctor or footcare clinician may note a “gap” in the tendon if it completely ruptured. A test involving compression of the calf muscle, in order to elicit plantar flexion of the foot, may also be performed in order to rule in or out a tendon rupture.
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Causes
Achilles tendon ruptures are the result of a sudden injury to the tendon. The Achilles tendon aids in plantarflexion of the foot, or pointing downward, as well as the push off strength when walking, jumping or running. The area most commonly ruptured is roughly 2.5 inches from the attachment onto the heel bone. This section is known as the watershed region as it tends to have poor blood flow and impaired healing potential. Typical types of injuries include falling from a height, stepping into a hole or sudden burst of activity or intensity. Age can play a role in rupture with 30-50 year olds being the most common population. Men are more likely to have a rupture than women. Steroid injections in the ankle joint area have been shown to cause weakening of the surrounding tissues, such as tendons. There is a link between certain oral antibiotics and tendon ruptures. Unfortunately since the Achilles is the largest tendon in the body it is at an increased risk with these medications.
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Treatment
The treatment options for an Achilles tendon tear are dependent on the age and activity level of the patient. Younger and more active patients, such as athletes, may opt for surgical intervention, while older, less active patients may opt for nonsurgical treatment. Nonsurgical treatment has shown to have optimal results. The nonsurgical approach involves resting the tendon by staying off of the injured limb, applying ice to the area, compression to aid with swelling, and immobilization via a pneumatic boot. Patients are often placed in slight plantar flexion to reduce any strain on the tendon. Your family doctor also plays a role in treatment with prescription anti-inflammatory medications. A professional will be able to monitor healing in order to obtain full rehabilitation. There is a slight increase in chances of re-rupture with a conservative approach, however there are less risks than when surgery is involved. Lastly, physical therapy has been to be successful in rebuilding the tendon and strengthening the tendon following rupture. Following the tendon healing, it is advisable to be properly fitted for footwear and if required, orthotics, to optimize your biomechanics.
