Overview
The Achilles tendon is the largest and strongest tendon in the body. It functions to help control the foot when walking and running. Ruptures of the Achilles tendon commonly occur in individuals in their 30s and 40s. This age group is affected because these patients are still quite active, but over time their tendons tend to become stiffer and gradually weaken. These ruptures usually occur when an athlete loads the Achilles in preparation to pushing off. This can occur when suddenly changing directions, starting to run, or preparing to jump. These ruptures occur because the calf muscle generates tremendous force through the Achilles tendon in the process of propelling the body. Patients will feel a sharp intense pain in the back of their heel. Patients often initially think that they were ?struck in the back of the heel? and then realize that there was no one around them. After the injury, patients will have some swelling. If they can walk at all, it will be with a marked limp. It is very rare that a rupture of the Achilles is partial. However, a painful Achilles tendonitis or a partial rupture of the calf muscle (gastrocnemius) as it inserts into the Achilles can also cause pain in this area. The pain of an Achilles rupture can subside quickly and this injury may be misdiagnosed in the Emergency Department as a sprain. Important clues to the diagnosis are an inability to push off with the foot and a visible or palpable defect just above the heel bone in the back of the leg.
Causes
The tendon is susceptible to injury and can rupture during vigorous activities such as running and jumping. Rupture can also occur as a result of gradual wear. After becoming chronically weakened, it can rupture during non-stress activities like walking.
Symptoms
Symptoms of an Achilles tendon rupture usually directly follow a traumatic event where the foot is forced in an upward position at the ankle, causing a sudden tight stretch of the Achilles tendon. There can also be a direct blow to the tendon causing a rupture. There is typically a popping feeling or even a popping sound described during the occurance of the rupture. Typically there is pain with swelling in the region. Often the patient is unable to put weight on this foot as there is too much pain.
Diagnosis
The doctor may look at your walking and observe whether you can stand on tiptoe. She/he may test the tendon using a method called Thompson?s test (also known as the calf squeeze test). In this test, you will be asked to lie face down on the examination bench and to bend your knee. The doctor will gently squeeze the calf muscles at the back of your leg, and observe how the ankle moves. If the Achilles tendon is OK, the calf squeeze will make the foot point briefly away from the leg (a movement called plantar flexion). This is quite an accurate test for Achilles tendon rupture. If the diagnosis is uncertain, an ultrasound or MRI scan may help. An Achilles tendon rupture is sometimes difficult to diagnose and can be missed on first assessment. It is important for both doctors and patients to be aware of this and to look carefully for an Achilles tendon rupture if it is suspected.
Non Surgical Treatment
To give the best prospects for recovery it is important to treat an Achilles' tendon rupture as soon as possible. If a complete rupture is treated early the gap between the two ends of the tendon will be minimised. This can avoid the need for an operation or tendon graft. There are two forms of treatment available for an Achilles' tendon rupture; conservative treatment and surgery. Conservative treatment will involve the affected leg being placed in a cast and series of braces with the foot pointing down to allow the two ends of the tendon to knit together naturally.
Surgical Treatment
In general, Achilles tendon repair surgery has a much higher success rate and lower incidences of re-rupture than non-surgical methods of treatment. It is preferred by the nation?s leading athletes as the best course of action, allowing them to return to previous activity and performance levels at a much faster rate, with a lower chance or re-injury and less potential muscle loss.
The Achilles tendon is the largest and strongest tendon in the body. It functions to help control the foot when walking and running. Ruptures of the Achilles tendon commonly occur in individuals in their 30s and 40s. This age group is affected because these patients are still quite active, but over time their tendons tend to become stiffer and gradually weaken. These ruptures usually occur when an athlete loads the Achilles in preparation to pushing off. This can occur when suddenly changing directions, starting to run, or preparing to jump. These ruptures occur because the calf muscle generates tremendous force through the Achilles tendon in the process of propelling the body. Patients will feel a sharp intense pain in the back of their heel. Patients often initially think that they were ?struck in the back of the heel? and then realize that there was no one around them. After the injury, patients will have some swelling. If they can walk at all, it will be with a marked limp. It is very rare that a rupture of the Achilles is partial. However, a painful Achilles tendonitis or a partial rupture of the calf muscle (gastrocnemius) as it inserts into the Achilles can also cause pain in this area. The pain of an Achilles rupture can subside quickly and this injury may be misdiagnosed in the Emergency Department as a sprain. Important clues to the diagnosis are an inability to push off with the foot and a visible or palpable defect just above the heel bone in the back of the leg.
Causes
The tendon is susceptible to injury and can rupture during vigorous activities such as running and jumping. Rupture can also occur as a result of gradual wear. After becoming chronically weakened, it can rupture during non-stress activities like walking.
Symptoms
Symptoms of an Achilles tendon rupture usually directly follow a traumatic event where the foot is forced in an upward position at the ankle, causing a sudden tight stretch of the Achilles tendon. There can also be a direct blow to the tendon causing a rupture. There is typically a popping feeling or even a popping sound described during the occurance of the rupture. Typically there is pain with swelling in the region. Often the patient is unable to put weight on this foot as there is too much pain.
Diagnosis
The doctor may look at your walking and observe whether you can stand on tiptoe. She/he may test the tendon using a method called Thompson?s test (also known as the calf squeeze test). In this test, you will be asked to lie face down on the examination bench and to bend your knee. The doctor will gently squeeze the calf muscles at the back of your leg, and observe how the ankle moves. If the Achilles tendon is OK, the calf squeeze will make the foot point briefly away from the leg (a movement called plantar flexion). This is quite an accurate test for Achilles tendon rupture. If the diagnosis is uncertain, an ultrasound or MRI scan may help. An Achilles tendon rupture is sometimes difficult to diagnose and can be missed on first assessment. It is important for both doctors and patients to be aware of this and to look carefully for an Achilles tendon rupture if it is suspected.
Non Surgical Treatment
To give the best prospects for recovery it is important to treat an Achilles' tendon rupture as soon as possible. If a complete rupture is treated early the gap between the two ends of the tendon will be minimised. This can avoid the need for an operation or tendon graft. There are two forms of treatment available for an Achilles' tendon rupture; conservative treatment and surgery. Conservative treatment will involve the affected leg being placed in a cast and series of braces with the foot pointing down to allow the two ends of the tendon to knit together naturally.
Surgical Treatment
In general, Achilles tendon repair surgery has a much higher success rate and lower incidences of re-rupture than non-surgical methods of treatment. It is preferred by the nation?s leading athletes as the best course of action, allowing them to return to previous activity and performance levels at a much faster rate, with a lower chance or re-injury and less potential muscle loss.