The Achilles tendon is at the back of the heel. It can be ruptured by sudden force on the foot or ankle. If your Achilles tendon is ruptured you will be unable to stand on tiptoe, and will have a flat-footed walk. It is important to diagnose and treat this injury as soon as possible, to help promote healing. Treatment involves wearing a plaster cast or brace (orthosis) for several weeks, and possibly having an operation.
The exact cause of Achilles tendon ruptures is hard to say. It can happen suddenly, without warning, or following an Achilles tendonitis . It seems that weak calf muscles may contribute to problems. If the muscles are weak and become fatigued, they may tighten and shorten. Overuse can also be a problem by leading to muscle fatigue . The more fatigued the calf muscles are, the shorter and tighter they will become. This tightness can increase the stress on the Achilles tendon and result in a rupture. Additionally, an imbalance of strength of the anterior lower leg muscles and the posterior lower leg muscles may also put an athlete at risk for an injury to the Achilles tendon. An Achilles tendon rupture is more likely when the force on the tendon is greater than the strength of the tendon. If the foot is dorsiflexed while the lower leg moves forward and the calf muscles contract, a rupture may occur. Most ruptures happen during a forceful stretch of the tendon while the calf muscles contract. Other factors that may increase the risk of Achilles tendon rupture include. Tight calf muscles and/or Achilles tendon. Change in running surface eg: from grass to concrete. Incorrect or poor footwear. A change of footwear eg: from heeled to flat shoes. It is thought that some medical conditions, such as gout, tuberculosis and systemic lupus erythematosus, may increase the risk of Achilles tendon rupture.
Patients with an Achilles tendon rupture will often complain of a sudden snap in the back of the leg. The pain is often intense. With a complete rupture, the individual will only be ambulate with a limp. Most people will not be able to climb stairs, run, or stand on their toes. Swelling around the calf may occur. Patients may often have had a sudden increase in exercise or intensity of activity. Some patients may have had recent corticosteroid injections or use of fluoroquinolone antibiotics. Some athletes may have had a prior injury to the tendon.
Most Achilles tendon ruptures occur in people between 30 and 50 years old and such injuries are often sport-related. If you suspect an Achilles injury, it is best to apply ice, elevate the leg, and see a specialist. One of the first things the doctor will do is evaluate your leg and ankle for swelling and discoloration. You may feel tenderness and the doctor may detect a gap where the ends of the tendon are separated. In addition to X-rays, the calf squeeze, or Thompson test, will be performed to confirm an Achilles tendon rupture. With your knee bent, the doctor will squeeze the muscles of your calf and if your tendon is intact the foot and ankle will automatically flex downward. In the case of a ruptured Achilles there will be no movement in the foot and ankle during the test.
Non Surgical Treatment
Once a diagnosis of Achilles tendon rupture has been confirmed, a referral to an orthopaedic specialist for treatment will be recommended. Treatment for an Achilles tendon rupture aims to facilitate the torn ends of the tendon healing back together again. Treatment may be non-surgical (conservative) or surgical. Factors such as the site and extent of the rupture, the time since the rupture occurred and the preferences of the specialist and patient will be considered when deciding which treatment will be undertaken. Some cases of rupture that have not responded well to non-surgical treatment may require surgery at a later stage. The doctor will immobilise the ankle in a cast or a special hinged splint (known as a ?moon boot?) with the foot in a toes-pointed position. The cast or splint will stay in place for 6 - 8 weeks. The cast will be checked and may be changed during this time.
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.
The following can significantly reduce the risk of Achilles tendon rupture. Adequate stretching and warming up prior to exercising. If playing a seasonal sport, undertake preparatory exercises to build strength and endurance before the sporting season commences. Maintain a healthy body weight. This will reduce the load on the tendon and muscles. Use footwear appropriate for the sport or exercise being undertaken. Exercise within fitness limits and follow a sensible exercise programme. Increase exercise gradually and avoid unfamiliar strenuous exercise. Gradual ?warm down? after exercising.