Achilles tendon rupture
The Achilles Tendon
The Achilles tendon is a strong, fibrous band of tissue that connects the muscles if the calf to the heel bone. It is the largest and strongest tendon in the body, and it plays a crucial role in helping us walk, run, and jump. However, the Achilles tendon is also prone to injury, and one of the most serious injuries it can sustain is a rupture.
The Achilles tendon is a thick tissue connecting the calf muscle to the heel bone (calcaneus).
Mechanism and Risk Factors
A rupture is a partial or complete tear of the Achilles tendon. This can happen as the result of an acute injury, such as a sudden, forceful contraction of the muscle, or it can be the result of repetitive stress on the tendon over time. Risk factors for Achilles tendon rupture include advancing age, male gender, and certain medical conditions such as diabetes and rheumatoid arthritis. Some medications, including antibiotics (ciprofloxacin or levofloxacin) can make the Achilles prone to rupture.
An acute Achilles tendon rupture feels like a sudden, sharp pain in the back of the lower leg, described as “a pop” or "being kicked in the back of the ankle". Afterwards, people have difficulty walking or bearing weight on the affected foot, and swelling or tenderness in the area of the injury.
The Achilles most often ruptures a few cm higher than its attachment. Complete ruptures cause a discontinuity of the muscle-tendon complex.
Diagnosis
When an Achilles rupture is suspected, urgent medical evaluation is recommended. The diagnosis should involve a thorough history of symptoms and how the injury occurred, along with a physical examination checking for swelling, tenderness, and gapping in the tendon. The Achilles should be checked with the patient lying on his belly. When a tendon is completely ruptured, a squeeze of the calf muscle will not cause the ankle to flex. This is called a positive Thompson’s test. X-rays are typically useful to rule out bony injury, but an MRI is not necessary in most cases.
Management
Treatment for an Achilles tendon rupture can involve surgery or rehabilitation without surgery. Both strategies have proven very effective and allow patients to return to full function when the injury is diagnosed and treated promptly. In both cases, the leg is typically wrapped and immobilized in a boot or a splint and there is no weight placed on the leg to allow for healing. The decision for surgical versus non-surgical treatment requires a personalized discussion with your doctor, taking into account your overall health, fitness level, and weighing the distinct risks and benefits of each option. An orthopedic surgeon, especially one with sports or foot and ankle specialization can best help you make important treatment decisions and get you back on your feet.
