A tendon is a band of tissue that connects a muscle to a bone. The Achilles tendon runs down the back of the lower leg and connects the calf muscle to the heel bone. This is also references as the heel cord. The Achilles tendon is the strongest tendon in the body and assists with walking/running to push off and move the foot in a downward (plantarflexion) position.
Achilles Tendon Rupture
An Achilles tendon rupture is a complete or partial tear that occurs when the tendon is stretched beyond its capacity to withstand the force applied. Forceful jumping or pivoting, or sudden accelerations of running, can overstretch the tendon and cause a tear. An injury to the tendon can also result from falling or tripping.
Achilles tendon ruptures are commonly seen with weekend warriors – typically, middle-aged men or woman participating in sports in their spare time. At times steroid medication and antibiotics (ciprofloxaxin) may weaken the tendon and cause a rupture.
Signs and Symptoms
A person with a ruptured Achilles tendon may experience one or more of the following:
- Sudden pain (which feels like a kick or a stab) in the back of the ankle or calf.
- This pain often subsides to a dull ache.
- A popping or snapping sensation.
- Swelling and bruising on the back of the leg between the heel and the calf
- Difficulty walking (especially upstairs or uphill) and difficulty rising up on the toes.
- Difficult moving the foot in the downward position.
X-rays will typically be ordered to rule out other injuries. An MRI is ordered in order to determine the extent of the tear as well as determine surgical planning should surgery be warranted. At times an ultrasound can be ordered to evaluate the tendon in motion.
Mid substance Achilles tendon ruptures occur more frequently (75-80%); however insertion injuries as well as injuries at the muscle tendon junction can also occur.
- Rest. Stay off the injured leg.
- Ice. Apply an ice pack to the injured area as well as behind the knee placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
- Compression. An elastic wrap may be recommended by your surgeon to control swelling.
- Elevation. The foot/ankle should be raised slightly above the level of your heart to reduce swelling.
- Medications. To help relieve the pain, the surgeon may prescribe pain medications or anti-inflammatory drugs for non-operative Achilles tendon ruptures.
After your surgeon has determined the severity of your rupture through the clinical exam and diagnostic modalities various surgical techniques are recommended to repair the rupture. The surgeon will select the procedure best suited to the patient.
Complications such as incision-healing difficulties, re-rupture of the tendon, or nerve pain can arise after surgery.
Ideally surgery is scheduled 6-14 days following the injury to allow the soft tissue swelling to subside; however this may be delayed due to the MRI.