Achilles tendon rupture
Definition
First, there's a pop or a snap. Then an immediate sharp pain in the back of your
ankle and lower leg that makes it impossible to walk properly. It almost feels like
you've been kicked, or even shot.
These are the sensations typical of an Achilles tendon rupture. The Achilles
tendon is a large, strong fibrous cord that connects the muscles in the back of
your lower leg to your heel bone.
If you overstretch your Achilles tendon, it can tear (rupture). An Achilles tendon
rupture can be partial or complete. Usually an Achilles tendon rupture occurs just
above your heel bone, but it can happen anywhere along the tendon.
Although other injuries affecting your Achilles tendon often improve with home
treatment, an Achilles tendon rupture often requires surgical repair.
Symptoms
Signs and symptoms of an Achilles tendon rupture include:
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Pain, possibly severe, and swelling near your heel
An inability to bend your foot downward or walk normally
An inability to rise on your toes on the injured leg, if you've ruptured the
tendon completely
Often people report hearing a popping or snapping sound when the injury occurs.
With a partial rupture, you may still be able to move your foot, and you may
experience only minor pain and swelling.
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If you haven't torn your Achilles tendon, you may be experiencing other
conditions involving your Achilles tendon, such as bursitis or tendinitis. Here's
how they affect your Achilles tendon:
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Bursitis. Bursae — tiny sacs of fluid located throughout your body —
cushion movement between bones and muscles and tendons attached to
bones, facilitating movement by limiting friction. Bursitis is inflammation
and irritation of a bursa. Inflammation can occur in the bursa between your
heel bone (calcaneus) and your Achilles tendon. This type of bursitis is
called retrocalcaneal bursitis.
Bursitis involving the area where your Achilles tendon attaches to your
heel bone usually begins with pain and irritation at the back of the heel.
There may be visible redness and swelling in the area, and the back of
your shoe may cause further irritation.
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Tendinitis. Achilles tendinitis is inflammation of your Achilles tendon. The
pain is the result of tiny tears and inflammation in the tissue of the tendon
itself. Tendinitis of the Achilles tendon usually develops just above the
attachment point of the tendon to your heel bone. Signs and symptoms
that you may have Achilles tendinitis include swelling, and pain when
pushing off during walking or after periods of rest.
Causes
Your Achilles tendon helps you point your foot downward, rise on your toes and
push off your foot as you walk. You rely on it virtually every time you move your
foot. Injuries to your Achilles tendon — also called your heel cord — result from
repeated stress on the tendon, which may be caused or aggravated by:
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Overuse
Running on hills and hard surfaces
Poor stretching habits
Tight calf muscles
Weak calf muscles
Worn-out or ill-fitting shoes
Flatfeet
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Injuries to your Achilles tendon can often result from taking part in an activity
involving stop-and-start footwork for which you're not conditioned or for which
you haven't stretched properly. This might include playing tennis, racquetball or
basketball for the first time after a long break.
Sometimes, though, injuries can occur from simply putting too much stress on
your Achilles tendon in the course of a simple activity, such as gardening.
Occasionally, even highly conditioned athletes may rupture an Achilles tendon.
As you age, the risk of Achilles tendon rupture may increase. If you don't
exercise regularly, the Achilles tendon may weaken and become thin, making it
more susceptible to injury.
When to seek medical advice
See your doctor if you experience persistent pain near the back of your heel or in
the area of your Achilles tendon, and especially if the pain doesn't greatly
improve despite self-care measures.
See your doctor immediately if you experience signs or symptoms of an Achilles
tendon rupture.
Tests and diagnosis
To diagnose Achilles tendon problems, your doctor will likely ask questions about
your physical activities and perform an examination of your feet, ankles and legs.
If it's clear that your Achilles tendon is ruptured, surgical repair will likely be
considered.
If there's a question about a partial or complete rupture of your Achilles tendon,
your doctor may order a magnetic resonance imaging (MRI) scan, a painless
procedure that uses magnetic fields to create a computer image of the tissues of
your body.
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Treatments and drugs
Treatment for Achilles tendon ruptures can be surgical or nonsurgical.
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Surgery. Surgery is a common treatment for a complete rupture of the
Achilles tendon. The procedure generally involves making an incision in
the back of your lower leg and stitching the torn tendon together.
Depending on the condition of the torn tissue, the repair may be reinforced
with other tendons.
Afterward, you'll need to spend about six to eight weeks with your leg in a
walking boot, cast, brace or splint. To promote healing and to avoid
stretching the surgical repair, your foot may initially be pointed slightly
downward in the boot or brace, and then moved gradually to a neutral
position.
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Nonsurgical treatment. This approach typically involves wearing a cast
or walking boot, which allows the ends of your torn tendon to reattach
themselves on their own. This method can be effective, and it avoids the
risks, such as infection, associated with surgery. However, the likelihood
of re-rupture is higher with a nonsurgical approach, and recovery can take
longer. If re-rupture occurs, surgical repair may be more difficult.
If you are very active and want to resume strenuous sports or recreational
activities, surgical repair is usually preferable. Surgery is generally very effective,
and your risk of complications is typically quite low. If you are less active or have
a chronic illness, you may wish to opt for nonsurgical treatment, which precludes
wound complications and exposure to anesthesia.
Rehabilitation
After treatment, whether surgical or nonsurgical, you'll go through a rehabilitation
program involving physical therapy exercises to strengthen your leg muscles and
Achilles tendon. Most people return to their former level of activity within four to
six months. Recovery depends not only on the quality of the rehab program, but
also on your commitment.
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Prevention
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Calf stretch exercise
To help prevent an Achilles tendon injury, gently stretch your Achilles tendon and
calf muscles before taking part in physical activities. Perform stretching exercises
slowly, stretching to the point at which you feel a noticeable pull, but not pain.
Don't bounce during a stretch.
To further reduce your chance of developing Achilles tendon problems, follow
these tips:
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Avoid activities that place excessive stress on your heel cords, such as
hill-running and jumping activities (especially if done consistently).
If you notice pain during exercise, rest.
If one exercise or activity causes you persistent pain, try another.
Alternate high-impact sports, such as running, with low-impact sports,
such as walking, biking or swimming.
Maintain a healthy weight.
Wear well-fitting athletic shoes with proper cushioning in the heels.
Strengthening your calf muscles also can help prevent injury to your Achilles
tendon. To strengthen your calf muscles, practice toe raises:
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Stand flat, then rise up on your toes.
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Hold the elevated position momentarily before slowly dropping back down
to a stand. Emphasizing the slow return to the ground will help improve
the force-absorbing capability of your calf muscle and Achilles tendon.
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Start with raising just your body weight. Later, you can add hand weights
as you do this exercise or raise your body weight on just one foot.
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To avoid a recurrence of an Achilles tendon injury, follow these guidelines:
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Use warm-up and cool-down exercises and calf-strengthening exercises.
Apply ice to your Achilles tendon after exercise.
Alternate high-impact sports with low-impact sports, so as not to overwork
your Achilles tendons.
Lifestyle and home remedies
If you experience any of the signs and symptoms of Achilles tendon rupture —
are unable to rise on your toes, have difficulty bearing weight due to pain or have
noticeable swelling in the region of your tendon — see your doctor. A rupture
should be treated by a professional, not by self-care measures at home.
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