ACHILLES TENDON RUPTURE

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Achilles tendon rupture is an injury that affects the back of your lower leg. It mainly occurs in people playing recreational sports, but it can happen to anyone.

The Achilles tendon is a strong fibrous cord that connects the muscles in the back of your calf to your heel bone. If you overstretch your Achilles tendon, it can tear (rupture) completely or just partially.

If your Achilles tendon ruptures, you might hear a pop, followed by an immediate sharp pain in the back of your ankle and lower leg that is likely to affect your ability to walk properly. Surgery is often performed to repair the rupture. For many people, however, nonsurgical treatment works just as well.

ACHILLES TENDON ANATOMY

DISEASE EXPLAINED

SYMPTOMS

Although it's possible to have no signs or symptoms with an Achilles tendon rupture, most people have:

The feeling of having been kicked in the calf

Pain, possibly severe, and swelling near the heel

An inability to bend the foot downward or "push off" the injured leg when walking

An inability to stand on the toes on the injured leg

A popping or snapping sound when the injury occurs

CAUSES

Your Achilles tendon helps you point your foot downward, rise on your toes and push off your foot as you walk. You rely on it virtually every time you walk and move your foot.

Rupture usually occurs in the section of the tendon situated within 2 1/2 inches (about 6 centimeters) of the point where it attaches to the heel bone. This section might be prone to rupture because blood flow is poor, which also can impair its ability to heal.

Ruptures often are caused by a sudden increase in the stress on your Achilles tendon. Common examples include:

Increasing the intensity of sports participation, especially in sports that involve jumping

Falling from a height

Stepping into a hole

TREATMENT

TREATMENT OPTIONS

Treatment for a ruptured Achilles tendon often depends on your age, activity level and the severity of your injury. In general, younger and more active people, particularly athletes, tend to choose surgery to repair a completely ruptured Achilles tendon, while older people are more likely to opt for nonsurgical treatment.

Recent studies, however, have shown fairly equal effectiveness of both surgical and nonsurgical management.

NONSURGICAL TREATMENT

This approach typically involves:

Resting the tendon by using crutches

Applying ice to the area

Taking over-the-counter pain relievers

Keeping the ankle from moving for the first few weeks, usually with a walking boot with heel wedges or a cast, with the foot flexed down

Nonoperative treatment avoids the risks associated with surgery, such as infection.

However, a nonsurgical approach might increase your chances of re-rupture and recovery can take longer, although recent studies indicate favorable outcomes in people treated nonsurgically if they start rehabilitation with weight bearing early.

SURGERY
The procedure generally involves making an incision in the back of your lower leg and stitching the torn tendon together. Depending on the condition of the torn tissue, the repair might be reinforced with other tendons.

Complications can include infection and nerve damage. Minimally invasive procedures reduce infection rates over those of open procedures.

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