Achilles tendon rupture

A loud “pop” in the
back of the ankle followed by a sharp pain that
makes it impossible to walk properly on the foot
may signal an Achilles tendon rupture. Some
describe it as feeling like being kicked, or even
shot, in the back of the foot. A strong band of tissue
named after the indestructible mythological
Greek warrior, the Achilles tendon is the continuation
of the large calf muscles, and it connects
these muscles in the back of the lower leg to the
heel bone, serving as the power source for pushing
off with the foot. It helps point your foot downward,
rise up on the toes, and push off in walking.
Basketball, tennis, and football players are especially
vulnerable to Achilles tendon ruptures, since
their sports require so much jumping and abrupt
start-and-stop footwork. But anyone, even gardeners who may overstress the tendon while kneeling
in one position too long on an ambitious spring
day, can suffer this painful injury.

Causes
Achilles tendon ruptures and partial tears most
often occur during sports that require quick cutting
and jumping motions. In these cases, the tear or
rupture results from a violent contraction of the
large calf muscles. Rarely does it involve contact
with another player. Achilles tendon injuries,
including ruptures, also result from repeated stress
on the tendon. This repeated stress may develop
from the following conditions:
• simple overuse
• failure to stretch properly
• running on hills and hard surfaces
• worn-out shoes
• flat feet
• weak or tight calf muscles

Achilles tendon ruptures are more likely to occur
in people who have a long history of ACHILLES TENDONITIS,
or inflammation of the Achilles tendon. In
addition, poor conditioning, advanced age, and
overexertion put people at risk of experiencing an
Achilles tendon injury. Despite these risk factors, it
is not uncommon for well-conditioned athletes to
experience Achilles tendon ruptures.

Diagnosis
Achilles tendon ruptures, which can be partial or
complete, usually occur just above above the heel
bone, although they can occur anywhere along the
tendon. They are diagnosed by a history of a sudden
injury followed by a “pop” felt behind the ankle.
The injury is confirmed by squeezing the calf muscles.
If the foot does not move, the tendon is probably
torn. In addition, pain and swelling near the heel
and an inability to bend the foot downward or walk
on it normally indicate a torn or ruptured Achilles
tendon. If the tendon is completely ruptured, the
patient will be unable to rise up on the toes on the
injured leg. The pain is sometimes severe.
Occasionally, a MAGNETIC RESONANCE IMAGING
(MRI) scan may be ordered. The computer image
created by the MRI shows the soft tissues of the body
and allows the doctor to determine if the injury is a
partial tear of the tendon or a complete rupture.

Treatment
Treatment for Achilles tendon rupture may involve
surgery. In most cases, a complete rupture is treated
with surgery, which involves making an incision at
the back of the leg and stitching the torn tendon
together. The recovery period lasts about six to 12
weeks, during which time the leg is placed in a walking
boot, cast, brace, or splint. Sometimes the foot
may initially be pointed slightly down in the boot or
brace, and then gradually moved to a neutral position,
in order to prevent the tendon from healing in
a stretched position, which would render it useless.
The benefits of surgical versus nonsurgical treatment
include a lower risk of re-rupture and a greater chance of restoring full strength to the leg,
making surgery the preferred treatment for active
patients. Risks of complications with this treatment
are very low but do include infection, scarring, and
poor healing of the wound.
The nonsurgical treatment for Achilles tendon
ruptures usually involves wearing a cast or walking
boot until the ends of the torn tendon have had a
chance to reattach themselves. This method can be
effective, but the incidence of re-rupture is higher
with nonsurgical treatment and the recovery
period usually lasts longer.

Prevention
As with many sports-related injuries, the keys to
avoiding a tear or rupture of the Achilles tendon
are proper stretching and warm-up exercises. Gently
stretch the Achilles tendon before participating
in physical activities. Stretching exercises should
be performed slowly, and the stretch should be
held until you feel a pull, but not pain.
An excellent stretch for the Achilles tendon is
the following:
• Stand at arm’s length from a wall and place the
palms of the hands flat against it.
• Step one leg back, keeping the knee straight and
the heel flat on the floor.
• Lean toward the wall, slowly bending the elbows
and the front knee.
• Hold the stretch for 30 to 60 seconds.
• Switch legs and repeat.