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Rupture of the Achilles tendon is a common injury in healthy, young, active individuals. The rupture is typically spontaneous and most commonly observed in individuals in between 24-45 years of age. The majority have had no prior history of pain or previous injury to the heel. In the majority of cases, rupture of the Achilles tendon occurs just a few centimeters above the heel bone. Common causes of Achilles tendinitis or rupture include advanced age, poor conditioning, and overexertion during exercise. In most cases, the individual rapidly performs activity like running or standing on the toes, which generates intense force on the tendon, leading to rupture. Achilles tendon rupture is often described as an abrupt break with instantaneous pain that is felt in the foot or heel area. The pain may radiate along the back of the leg and is often intense. Generally, walking may be difficult and the foot may drag. Most individuals claim that they felt like they were kicked in that area or even shot at. These symptoms lead to a suspicion of rupture of the Achilles tendon. Sometimes the tendon does not fully rupture but only a partial tear develops. The partial tear can also present with pain, and if not recognized, can rapidly develop into a full-blown rupture. In the majority of cases, the Achilles tendon rupture occurs just above the heel, but it may occur anywhere along the length of the tendon.
As with any muscle or tendon in the body, the Achilles tendon can be torn if there is a high force or stress on it. This can happen with activities which involve a forceful push off with the foot, for example, in football, running, basketball, diving, and tennis. The push off movement uses a strong contraction of the calf muscles which can stress the Achilles tendon too much. The Achilles tendon can also be damaged by injuries such as falls, if the foot is suddenly forced into an upward-pointing position, this movement stretches the tendon. Another possible injury is a deep cut at the back of the ankle, which might go into the tendon. Sometimes the Achilles tendon is weak, making it more prone to rupture. Factors that weaken the Achilles tendon are as follows. Corticosteroid medication (such as prednisolone) - mainly if it is used as long-term treatment rather than a short course. Corticosteroid injection near the Achilles tendon. Certain rare medical conditions, such as Cushing's syndrome, where the body makes too much of its own corticosteroid hormones. Increasing age. Tendonitis (inflammation) of the Achilles tendon. Other medical conditions which can make the tendon more prone to rupture; for example, rheumatoid arthritis, gout and systemic lupus erythematosus (SLE), lupus. Certain antibiotic medicines may slightly increase the risk of having an Achilles tendon rupture. These are the quinolone antibiotics such as ciprofloxacin and ofloxacin. The risk of having an Achilles tendon rupture with these antibiotics is actually very low, and mainly applies if you are also taking corticosteroid medication or are over the age of about 60.
If the Achilles tendon is ruptured you may experience a sudden pain in the back of your leg, as if someone had kicked you, followed by, swelling, stiffness, and difficulty to stand on tiptoe and push the leg when walking. A popping or snapping sound may be heard when the injury occurs. You may also feel a gap or depression in the tendon, just above heel bone. Ruptures usually occurs in those aged 30 - 70 years, during a sudden forceful push off from the foot. Without proper healing of the tendon, you will have a permanent limp and weakness when using the leg.
The actual area of an Achilles tendon rupture cannot be seen on x-ray. Therefore, although x-rays are often done to rule out bony injuries in individuals with an Achilles tendon rupture these x-rays are usually normal. Diagnostic ultrasound of the tendon can be performed to assess the integrity of the tendon. Other diagnostic tests, such as MRI's, may also be required in difficult cases.
Non Surgical Treatment
The treatments of Achilles tendonitis include resting the painful Achilles tendon will allow the inflammation to subside and allow for healing. A period of rest after the onset of symptoms is important in controlling Achilles tendonitis. In patients who have more significant symptoms, a period of immobilization can help. Either a removable walking boot or a cast can allow the inflamed tendon to cool down quickly. A heel wedge can be inserted into the shoe to minimize the stress on the Achilles tendon. These can be placed in both athletic and work shoes. Applying ice to the area of inflammation can help stimulate blood flow to the area and relieve the pain associated with inflammation. Apply ice several times a day, including after exercise. The pain and swelling most commonly associated with Achilles tendonitis can be improved with non-steroidal, anti-inflammatory medications (NSAIDs) which include Celebrex?, Advil?, Motrin?, Naprosyn?. Be sure to consult your physician before starting any medications. Physical therapists can help formulate a stretching and rehabilitation program to improve flexibility of the Achilles tendon. Cortisone injections should not be used for Achilles tendonitis. Studies have shown an increased incidence of Achilles tendon rupture after cortisone injections.
There are a variety of ways to repair an Achilles tendon rupture. The most common method is an open repair. This starts with an incision made on the back of the lower leg starting just above the heel bone. After the surgeon finds the two ends of the ruptured tendon, these ends are sewn together with sutures. The incision is then closed. Another repair method makes a small incision on the back of the lower leg at the site of the rupture. A series of needles with sutures attached is passed through the skin and Achilles tendon and then brought out through the small incision. The sutures are then tied together. The best surgical technique for your Achilles rupture will be determined by your orthopaedic foot and ankle surgeon.
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