The Achilles tendon is the largest tendon in your body. It a strong fibrous structure that connects two large muscles at the back of the calf, the gastrocnemius and the soleus, to your heel bone. This combination of tendon and muscles help you to anchor the leg, to stand on your toes and to point the foot and ankle downward while walking and running.
Every movement of your foot is dependent on the Achilles tendon. When overstretched, the fibers of Achilles tendon might tear or rupture. For example, an athlete running forward might feel a snap or acute pain at the back of his leg or ankle. In almost all cases this is an Achilles rupture. It could be either partial or complete. If the Achilles tendon snaps, a pop sound are heard, followed by acute pain in the ankle and lower leg, due to which you may not be able to walk properly.
The vast majority of ruptures occur about 4-6 cms above the heel, but sometimes the tendon can tear away from its point of insertion on the heel bone and, in doing so, is capable of pulling away a fragment of the heel bone.
Most ruptures occur in people in the age group between 30 and 50 years. Non surgical treatment is an effective surgical option, however, for many, surgery might be the best option to repair Achilles tendon rupture.
Achilles Tendon Tear Symptoms
Most common symptoms include -
Popping sound during injury
Swelling near the heel
Inability to bend injured foot downward
Inability to stand on toes of injured leg
In some people the Achilles tear might show no signs or symptoms
Achilles Tendon Tear Causes & Risk Factors
Achilles tendon ruptures are often caused by a spurt in stress on your Achilles tendon. Increased sports participation, especially athletics involving jumping, falling from a height or stepping into a hole can lead to Achilles tendon tear.
Risk factors include -
Age. Those between the ages of 30 to 50 are more prone to this injury.
Sex. Achilles tendon rupture is up to five times more common in men than in women.
Recreational sports. Achilles tendon injuries occur more frequently in those involved with sports that involve sudden starts and stops (soccer, basketball and tennis running) jumping.
Steroid injections to reduce pain and inflammation in the ankles can weaken the tendons of the leg and ankle leading to ruptures.
Certain antibiotics such as ciprofloxacin (Cipro) or levofloxacin (Levaquin), increase the risk of Achilles tendon rupture
Achilles Tendon Rupture Diagnosis
If you hear a popping sound and suspect a Achilles tendon injury, apply some ice, keep your leg elevated and seek medical help at the earliest.
Your doctor will carry out a physical exam during which he will inspect the back of your leg for swelling and discoloration. He will look for tenderness at the site of injury and check for a gap at the back of your lower leg where the tendons have separated. A calf squeeze or Thompson test may be performed in which you will be asked to lie on your stomach with your knee bent. The doctor would then squeeze your calf muscles. If the tendon is intact the foot and the ankle will automatically move downward. In case the tendon is ruptured, no movement will be detected.
To further analyze the nature of your Achilles tendon rupture an ultrasound or an MRI scan will be carried out.
Achilles Tendon Rupture Treatment
Treatment for Achilles tendon tear often depends on the severity of injury, besides your age and activity level. If you are young or middle aged, especially a sports person, your doctor would advise surgery to repair a tendon rupture, while nonsurgical treatment would be the method of choice if you are older. Recent studies, however, have revealed that both the treatment choices are equally effective.
This mode of treatment involves immobilizing the injured leg followed by rehabilitation. The injured leg is placed in a cast, with the foot and heel pointing downward, allowing the two ruptured ends of the tendon to come together and heal. Sometimes a walking boot with raised wedges to elevate the heel is worn. Non surgical methods avoid the risk of infection, but the time of healing is longer. Besides the chances of re-rupture are also higher, in comparison to those who have undergone surgery.
Surgery involves creating an incision at the back of the leg, mobilizing the two ends of the torn tendon and suturing them together. Surgery restores tension and length to the ruptured tendon. The chances of infection and nerve damage are higher with surgery, but if the incisions are smaller the rate of infection too is reduced. After surgery, your leg will be immobilized with the help of splint or a cast.
Once healing is initiated, after surgical or nonsurgical treatment, the doctor will recommend physical therapy and exercises to strengthen the leg muscles and Achilles tendon. Complete rehabilitation and return to your former level of activity will take four to six months.