Achilles Tendon Rupture The Facts

Overview

Achilles Tendinitis

The Achilles tendon is an important part of the leg. It is located just behind and above the heel. It joins the heel bone to the calf muscles. Its function is to help in bending the foot downwards at the ankle (this movement is called plantar flexion by doctors). If the Achilles tendon is torn, this is called an Achilles tendon rupture. The tear may be either partial or complete. In a partial tear, the tendon is partly torn but still joined to the calf muscle. With complete tears, the tendon is completely torn so that the connection between the calf muscles and the ankle bone is lost.


Causes

Ruptured Achilles tendons may result from falling from a height or down a hole. Increasing training intensity abruptly, boosting distance, frequency or duration by more than 10% a week. Failing to stretch before and after exercise. Repetitive training, especially uphill running. Deyhydration, which causes cramping and tightness in the calves. Taking antibiotics. Improper footwear. Explosive movements in competitive sports like basketball, soccer or track & field.


Symptoms

Although it’s possible to have no signs or symptoms with an Achilles tendon rupture, most people experience pain, possibly severe, and swelling near your heel, an inability to bend your foot downward or “push off” the injured leg when you walk, an inability to stand on your toes on the injured leg, a popping or snapping sound when the injury occurs. Seek medical advice immediately if you feel a pop or snap in your heel, especially if you can’t walk properly afterward.


Diagnosis

A doctor will look at the type of physical activity you have been doing. He or she will then look at your foot, ankle and leg. An MRI may also be used. This is to help determine the severity of the tear and the extent of separation of the fibers.


Non Surgical Treatment

There are two treatment options available which are non-operative and operative. Non-operative treatment involves the use initially of a below-knee plaster with the foot held fully bent downwards. This usually stays in place for 2 weeks then is changed for a brace(this is a boot from the knee down to the toes with Velcro straps) which should be worn day and night. The brace will be regularly altered to allow the foot to come up to a more neutral position. The brace will be on for a further 6 weeks. After the 8 weeks you will be referred for physiotherapy to regain movement and calf strength but will probably need to wear the brace during the day for a further 4 weeks. Non-operative treatment avoids the risks of surgery but the risk of the tendon re-rupturing, which normally occurs within 3 months of discarding the brace, is 10%.

Achilles Tendonitis


Surgical Treatment

Surgery to repair an Achilles tendon rupture is performed under a spinal or general anaesthetic. During surgery the surgeon makes an incision in the skin over the ruptured portion of the tendon. The tendon ends are located and joined together with strong sutures (stitches), allowing the tendon to closely approximate its previous length. The skin is then closed with sutures and the foot is immobilised in a cast or splint, again in the toes-pointed position. Seven to ten days after surgery the cast or splint is removed in order for the sutures in the skin to be removed. Another cast or splint will be applied and will stay in place a further 5 – 7 weeks.


Prevention

To help reduce your chance of getting Achilles tendon rupture, take the following steps. Do warm-up exercises before an activity and cool down exercises after an activity. Wear proper footwear. Maintain a healthy weight. Rest if you feel pain during an activity. Change your routine. Switch between high-impact activities and low-impact activities. Strengthen your calf muscle with exercises.

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