Achilles Tendon Rupture

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.

Diagnosis

In diagnosing an Achilles tendon rupture, your surgeon will ask questions about how and when the injury occurred and whether you have previously injured the tendon or experienced similar symptoms. A defect in the tendon suggests a tear. Inability to move the foot downward (plantarflex) when squeezing the calf muscle also suggests a tear. Range of motion and muscle strength will be evaluated and compared to the uninjured foot and ankle.

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.

Non-Surgical Treatment

Non-surgical treatment, which is associated with a higher rate of re-rupture as well as decreased strength to the injured Achilles. If non-surgical treatment is recommended it is typically selected for minor ruptures, less active patients, and those with medical conditions that prevent them from undergoing surgery. Non-surgical treatment involves use of a short leg cast or a removable boot to restrict motion and allow the torn tendon to heal.

• 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.

Surgery

Surgery offers important potential benefits. Including the the likelihood of decreasing the re-rupture of the Achilles tendon. Additionally surgery can increase the patient’s push-off strength and improve muscle function and movement of the ankle.

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.