What happens in an Achilles tendon rupture?
An Achilles tendon rupture describes either a partial or complete tear in the tendon, which occurs if the tendon is stretched beyond its capability. Achilles tendon rupture can occur from injury during physical activity, or from impact, such as falling over.
The Achilles tendon the strong, thick, cord-like structure that runs down the lower part of the back of your leg, connecting the bottom of your calf muscles (namely the plantaris, gastrocnemius and soleus muscles) to the back of the heel bone in our foot (the calcaneus). The Achilles tendon makes walking possible, by facilitating plantar flexion (lifting the heel up and pointing of the foot downwards) and knee flexion. One of the main symptoms in a patient with an Achilles tendon rupture is difficulty walking, because of this important function that the tendon makes possible.
Are there particular risk factors for an Achilles tendon rupture?
Achilles tendon rupture is most common in:
- middle-aged males (aged 30 years and over)
- those engaged in sports such as basketball, squash, tennis, gymnastics, volleyball and soccer, or any type of activity that requires carrying out forceful motions such as jumping, sudden accelerations or decelerations when running, or quick pivoting.
Some other factors that put a person at greater risk of Achilles tendon rupture include:
- wearing high heels, which stresses the Achilles tendon
- having “flat feet”, or fallen arches; each time the person steps, the arch of the foot flattens, pulling on the muscles and tendons in the lower leg
- poor flexibility in the tendons and muscles of the lower leg and foot
- taking particular medications, specifically antibiotics in the group ‘fluoroquinolones’ or corticosteroids, which may also weaken the Achilles tendon and lead to rupture.
The greatest risk factor for Achilles tendon rupture, however, is the weakening of the tendon caused by tendon cell degeneration, which occurs as a result of untreated or poorly managed Achilles tendinopathy.
What are the signs and symptoms of an Achilles tendon rupture?
Unfortunately, often the first sign of an Achilles tendon rupture is feeling a “pop” or “snap” in the back of your ankle. The pain is generally sudden and sharp and feels like a strike to the back of the ankle or calf, before eventually subsiding to a dull ache. A swelling may be visible at the back of the leg between the heel and calf. There will be difficulty walking, especially uphill, and difficulty pushing up onto the toes.
In the case that you experience any of the above symptoms, medical attention should be sought promptly. The RICE procedure is useful in preventing further injury until a doctor can be seen:
- Rest – stay off the injured foot and ankle
- Ice – an ice pack wrapped in a towel should be used for 20 minutes at a time in order to reduce swelling
- Compression – use an elastic bandage to apply firm but comfortable pressure on the injured foot
- Elevation – keep the leg elevated above the level of the heart to reduce swelling.
How is an Achilles tendon rupture diagnosed?
Diagnosing an Achilles tendon rupture is generally straight forward and your sports podiatrist will have had experience in seeing this type of injury. The sports podiatrist will collect a thorough history, including asking questions such as how and when the injury occurred and whether you have injured the tendon previously or ever experienced any similar symptoms. They will assess your strength and range of motion of the injured leg compared to the uninjured, and feel for a characteristic defect in the tendon that is indicative of a tear. A Thompson Test is commonly performed, where the patient lies face down on the table with their feet hanging off the edge. The podiatrist will squeeze the calf muscles. Squeezing the calf muscles should cause contraction of the Achilles tendon, and consequently, the foot should plantar flex (move away from the table and up, in this position). If there is an Achilles tendon rupture, there will be no apparent plantar flexion. In some cases, medical imaging, such as an ultrasound or MRI, may be ordered for detailed visualization of the structures in the injured foot.
How is an Achilles tendon rupture treated?
There are both surgical and non-surgical treatment options available for Achilles tendon rupture. The approach taken largely depends on the severity of the rupture (whether it is complete or partial) and the patient’s individual health status and level of participation in physical activity. Depending on the severity of the injury, return to physical activity may be in around 12 weeks from the commencement of treatment, or in complicated cases, around 6 months. Your sports podiatrist will discuss expected outcomes and a timeline for return to sport with you.
Are usually elected in cases where the rupture is minor, if the patient is less active, or if the patient has a medical condition that prevents them from undergoing surgery. Non-surgical treatments are associated with a higher rate of re-rupture. Non-surgical treatments usually involve the use of a brace, cast or Controlled Ankle Motion (CAM) boot that restricts movement in the heel and allows the tendon to heal over a period of time. Over-the-counter pain relief may be used, as well as covered ice packs over the painful area.
Surgery is often viewed as a favorable approach to treatment of Achilles tendon rupture, as it offers some benefits such as a decreased likelihood of re-rupture, increased push-off strength in the foot, improved range of motion of the ankle and improved muscle strength. Generally, if more than two weeks have passed between the injury and the diagnosis and bracing, surgery may be viewed as the more advantageous approach. There are numerous surgical techniques used to repair the ruptured tendon. The surgeon will choose the best technique based on the patient’s individual circumstances. The foot is immobilized in a cast, CAM boot, or brace following the repair, to allow healing time before the patient is allowed to weight-bear again. As with all surgeries, there are risks involved, which the surgeon will discuss with the patient prior to undergoing any surgical treatment.
Physical therapy (at the right time) is an important aspect of the healing process when treating Achilles tendon rupture, regardless of whether the patient is undergoing a surgical or non-surgical treatment plan. Physical therapy involves undertaking a carefully prescribed exercise and rehabilitation regime that facilitates the strengthening of the muscles of the lower leg and foot (when ready), and improvement of the range of motion of the foot and ankle. It is very important not to over-stress the healing Achilles tendon. It is imperative that the patient follows their physical therapy plan closely in order to have the best possible healing outcome when recovering from an Achilles tendon rupture.
The information published above is for informational purposes only and should not be taken as general advice. If you think that you may have experienced an Achilles tendon rupture or other injury, you should consult with an appropriately qualified sports podiatrist promptly to discuss your individual condition. You can make an appointment by emailing email@example.com or by calling 82110600.
Karl Lockett– sports podiatrist.