Achilles Tendon Rupture: Causes, Symptoms and Treatment

The Achilles Tendon, also known as calcaneal tendon is located at the back of the ankle. It is a rope like band made of fibrous tissues that connect the heel bone with the calf muscles. It is the largest tendon in the human body and is also sometimes called the heel cord. When you contract your calf muscles, it leads to tightening in the Achilles tendon which leads to the heel being pulled. This movement allows you to stand on your tiptoes and point your foot. The Achilles tendon plays a major role in activities such as jumping, running and walking. It is one of the most commonly injured tendons of the human body. It is usually caused when the tendon becomes painful and swollen or by tendinitis. In severe cases, a partial tear to the Achilles tendon occurs and in worst case scenario, the entire Achilles tendon may rupture.

Achilles Tendon Rupture – An Overview

An Achilles tendon rupture is an injury that most commonly occurs when playing recreational sports. It affects the back of your leg and is caused when the complete Achilles tendon ruptures as a result of a sudden or forceful action during an intense physical activity. When your Achilles tendon ruptures, you might feel a snap or a pop which is followed by a sharp pain in the lower leg and the back of your ankle. The best treatment option for an Achilles tendon rupture is surgery, however, there are other non-surgical treatments as well that work in many cases.

An Achilles tendon rupture is most common among male athletes in their middle age (the weekend warriors who engage in a pickup game of football for example). It usually occurs while playing recreational sports that require bursts of running, pivoting and jumping, such as badminton, basketball, tennis and racquetball.

 

Causes of An Achilles Tendon Rupture

As mentioned before, the Achilles tendon is one of the most used tendons in the body and has a massive job to do. The tendon is strong and can withstand great stress that accompanies activities like jumping, walking and running. However, the Achilles tendon tends to grow thin and weak with age, as well as, lack of use. This makes it prone to rupture and injuries. It is more common among people who have preexisting tendinitis. There are also certain medications such as antibiotics and corticosteroids, as well as certain medical conditions such as diabetes and arthritis that increase the risk of an Achilles tendon rupture.

An Achilles tendon rupture injury is usually caused in one of the following situations:

• A sudden forceful push-off with the foot while keeping the knee straight by the powerful thigh muscles, such as the case is with jumping or foot race.
• Stumbling or tripping suddenly while your foot is in front leading to overstretching of the tendon.
• Falling from a height and stepping off the curb or into a hole abruptly.

 

Symptoms of Achilles Tendon Rupture

The common symptoms of an Achilles tendon rupture include:

• A popping, cracking or snapping sound when the injury occurs
• Swelling and severe pain near your heel
• Not being able to stand on your toes on the injured leg
• Not being able to push the injured leg or bend the foot downward

If you are experiencing any of the above symptoms, it is recommended that you visit your doctor immediately so the condition does not worsen and timely diagnosis and treatment can be started.

 

Severity of an Achilles Tendon Rupture – Partial or Complete Tear

To check the severity of the rupture, the physician will perform tests such as the Thompson test, ultrasound, MRO or visual observation.

Partial Tear

• The middle part of the Achilles tendon is swollen and tender to touch
• Stiff and painful Achilles tendon, especially after long periods of inactivity

You might be able to walk with a partial tear in your Achilles tendon but will feel severe pain when your heel touches the ground and when you try to push off your toes.

 

Complete Rupture

• Severe pain in the Achilles tendon
• A loud pop or snap can be clearly heard when the injury takes place
• Pointing and flexing your foot will be difficult
• A palpable depression can be felt or a small gap is visible at the place of the injury in the back of your leg

If you have any of these symptoms, have your injury assessed and verified by a certified physician to prevent additional damage.

 

Treatment Options

Treatment Options for an Achilles tendon rupture include basic options to surgical procedures.

Basic Treatment for Managing Inflammation and Pain

• Icing – Swelling due to inflammation can be reduced by placing ice over the affected area. Make sure there is a thin material between your skin and ice to avoid injury to the skin. Icing can be done 3-4 times a day for 20 minutes. You can reduce the time of icing if the skin feels numb or gets red.

It is important to take plenty of rest with the icing treatment and you should not stretch or walk if you are in extreme pain.

Medications

To help relieve pain and initial discomfort during Achilles tendon rupture, you can use the following medications which are excellent not only for relieving pain but also for reducing inflammation.

• Ibuprofen (Advil and Motrin)
• Tylenol (Acetaminophen)
• Naproxen (Aleve)
• Topical Creams
• Generic Aspirin

It is important to strictly follow the dose and the medication prescribed by the physician to avoid serious damage to internal organs. Also tell your physician about any allergies you have before taking the medications.

 

Surgical Treatment

Two types of surgeries are performed for Achilles tendon rupture.

 

Open Surgery

Open surgery involves making one large incision on the affected area of the leg, removing the damaged tissue and then sewing cadaver tendon or transferring tendon from your big toe to the remaining part of the Achilles tendon to repair it and aid in strengthening it.

 

PARS Surgery

Percutaneous Achilles Repair System is a surgical procedure that involves a small incision in the back of your leg where the injury has occurred. In this procedure, the damaged tendon is not removed but it is used to make the repair. The incision (2 cm) is made 4-6 cm above the heel where the PARS device is inserted and the surgeon makes sutures all along the tendon. This procedure secures the two ends of the ruptured tendons together in a position where they can heal.

The procedure can only be performed if the injury is no more than 10 days old and there is a specialized physician present to carry out the surgery.

The Achilles tendon rupture surgery has positive outcomes but there are some risks involved as well. These risks include:

• Possible nerve damage
• Skin infection at the site of the incision
• Normal complications associated with anesthesia and surgery
• Loss of strength in the tendon
• Risk of damaging the tendon again
• Decrease in the range of motion of the tendon after surgery. Rehabilitation plays a vital role in getting the complete movement back

 

The Rehabilitation Process

You will be wearing a walking boot or a cast for 6-12 weeks post-surgery, which will keep your toes pointed downwards. It is later adjusted to bring your foot back in the neutral position. It is important not to walk on the injured leg and not put any weight on the injured foot. There are many choices when it comes to bearing your weight. You can choose any one of the following.

Traditional Crutches

Crutches allow you to keep your weight off your injured leg. These might be readily available and inexpensive, yet there are many disadvantages associated with it that you should be aware of. The number one complaint from people using these crutches is pain in the wrists, under your arms, elbows and hand. It becomes difficult to do every day work such as walking through a door, going to work, pushing a shopping cart. All this leads to occasional weight bearing on the injured and freshly mended leg which can cause the injury again or increase the recovery time.

 

Knee Walkers or Knee Scooters

These are becoming common to make the rehabilitation process easy. The knee scooter lets the user bend their knee at an angle of 90-degrees and kneel on the platform on a frame attached to four wheels. It works like a bicycle and the user can steer it easily using the handles.

Knee scooters by KneeRover are a great improvement for long distance mobility and provides the user freedom to move as soon as the doctor advises after the surgery. It provides comfort and keeps your weight off your recently mended Achilles tendon.

As mentioned earlier, the Achilles tendon is the biggest tendon of your body and it needs time to heal properly. Once your physician is sure it has healed, you will have to go through sessions of physical therapy which can consist of anything from strengthening and stretching exercises. Ultrasound heat therapy and deep massages. The time it will take to heal your injury depends on its severity but on an average, it takes about 4-6 months to get back to activities like running and another 4-6 months before you are pain free.

 

Injuries to the Achilles tendon are common and can have a major impact on our routine lives. It is important to make sure that you see a physician as soon as you suspect there is something wrong with your Achilles tendon so that treatment can begin right away and serious damage can be avoided.

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