An Achilles tendon rupture is also known as a rupture of the gastrocnemius tendon, or the common calcanean tendon. The tendon is actually composed of 5 different tendons, the two most important being the superficial digital flexor and gastrocnemius tendons. The gastrocnemius tendon is the largest of these, and is the most powerful extensor of the hock (ankle) joint. Both the superficial digital flexor and gastrocnemius tendons attach to the heel bone, called the calcaneus bone. A rupture of the Achilles tendon may be a partial tear, which means just the gastrocnemius is torn, or a complete tear, in which all five tendons have been torn. (show diagrams, normal anatomy vs partial vs complete tears).
The most common cause of a ruptured Achilles' tendon is when too much stress is placed through the tendon, particularly when pushing off with the foot. This may happen when playing sports such as football, basketball or tennis where the foot is dorsiflexed or pushed into an upward position during a fall. If the Achilles' tendon is weak, it is prone to rupture. Various factors can cause weakness, including corticosteroid medication and injections, certain diseases caused by hormone imbalance and tendonitis. Old age can also increase the risk of Achilles' tendon rupture.
Although it's possible to have no signs or symptoms with an Achilles tendon rupture, most people experience pain, possibly severe, and swelling near your heel, an inability to bend your foot downward or "push off" the injured leg when you walk, an inability to stand on your toes on the injured leg, a popping or snapping sound when the injury occurs. Seek medical advice immediately if you feel a pop or snap in your heel, especially if you can't walk properly afterward.
On physical examination the area will appear swollen and ecchymotic, which may inhibit the examiners ability to detect a palpable defect. The patient will be unable to perform a single heel raise. To detect the presence of a complete rupture the Thompson test can be performed. The test is done by placing the patient prone on the examination table with the knee flexed to 90?, which allows gravity and the resting tension of the triceps surae to increase the dorsiflexion at the ankle. The calf muscle is squeezed by the examiner and a lack of planar flexion is noted in positive cases. It is important to note that active plantar flexion may still be present in the face of a complete rupture due to the secondary flexor muscles of the foot. It has been reported that up to 25% of patients may initially be missed in the emergency department due to presence of active plantar flexion and swelling over the Achilles tendon, which makes palpation of a defect difficult.
Non Surgical Treatment
You may need to wear a plaster cast, brace or boot on your lower leg for six to eight weeks to help the tendon heal. During this time, your doctor will change the cast a number of times to make sure your tendon heals in the right way. If your tendon is partially ruptured, your doctor will probably advise you to have this treatment instead of surgery. It?s also suitable for people who aren't very physically active. However, there is a greater risk that your tendon will rupture again, compared with surgery. Your doctor will advise you which treatment is best for you.
Surgery is recommended to those who are young to middle-aged and active. The ruptured tendon is sewn together during surgery. This is an outpatient procedure. Afterward the leg is put into a splint cast or walking boot. Physical therapy will be recommended. In about 4 to 6 months, healing is nearly complete. However, it can take up to a year to return to sports fully.
To reduce your chance of developing Achilles tendon problems, follow the following tips. Stretch and strengthen calf muscles. Stretch your calf to the point at which you feel a noticeable pull but not pain. Don't bounce during a stretch. Calf-strengthening exercises can also help the muscle and tendon absorb more force and prevent injury. Vary your exercises. Alternate high-impact sports, such as running, with low-impact sports, such as walking, biking or swimming. Avoid activities that place excessive stress on your Achilles tendons, such as hill running and jumping activities. Choose running surfaces carefully. Avoid or limit running on hard or slippery surfaces. Dress properly for cold-weather training and wear well-fitting athletic shoes with proper cushioning in the heels. Increase training intensity slowly. Achilles tendon injuries commonly occur after abruptly increasing training intensity. Increase the distance, duration and frequency of your training by no more than 10 percent each week.