Achilles Tendon Rupture – Causes, Symptoms, Treatment, Prevention

The Achilles tendon is the strongest and thickest tendon in the body present at the back of the lower part of the leg (ankle). This tendon connects the three calf muscles to the heel bone. The Achilles tendon undergoes constant strain throughout life but if well conditioned, this does not usually cause a problem. However, when the tendon is subjected to strain that it cannot manage then it can lead to inflammation and even tearing of the tendon.

What is Achille’s tendon rupture?

Achille’s tendon rupture is tearing of the Achilles tendon due to overstretching. The tear may be partial or complete. This type of injury is most common in people playing recreational sports, particularly where they are not conditioned for the level of physical activity.  The most common complain of Achilles tendon rupture is feeling a pop or snap immediately accompanied with sharp stabbing pain at the back of the lower leg.

A tendon rupture may or may not be preceded by Achilles tendonitis, which is inflammation of the tendon. With proper treatment and management, Achilles tendonitis may not lead to a ruptured tendon.  However, if an Achilles tendon rupture does occur then it can be treated by both medical and surgical interventions.

Signs and Symptoms

Achilles tendonitis generally cause pain, stiffness in moving the foot and some difficulty with walking. However, sometimes a partial Achille’s tendon rupture may not cause any significant symptoms. Most people will experience the following symptoms with an Achilles tendon rupture. This includes:

  • Severe excruciating pain at the back of the leg.
  • Swelling at the back of the ankle.
  • Sudden popping or snapping sound.
  • Inability to bend the affected foot downwards, stand on the toes of the affected foot and difficulty in walking.

Medical attention must be sought if there are even non-specific  symptoms such as swelling at the back of the leg and difficulty walking. While it may be Achilles tendonitis which needs to be treated, it is possible that a partial tear of the tendon may also occur without the characteristic symptoms discussed above.

Read more on ankle pain.

Causes of Achilles Tendon Rupture

Tendons are tough cords of connective tissue which connects the ends of the muscles to bones. The Achilles tendon being the thickest and strongest is about 15 centimeters long. It connects the calf muscles to the heel bone and starts from the middle portion of the calf muscles.

The Achilles tendon is essential for walking, standing on the toes and pointing the foot downwards. The most common site of rupture is approximately one-third to halfway through tendon at the point where it inserts into the heel bone. A reduced blood supply to this part of the tendon makes it prone to injury.

An Achilles tendon rupture can occur with any trauma to the lower leg and ankle region. However, most of the time it is due to excessive strain and stretching. This is often due to strenuous recreational activities like playing sports occasionally where a person is not conditioned to handle the exertion. It can also occur with accidents like falling from a height or stepping into a hole while walking or running.

Some people are at a greater risk of an Achilles tendon rupture. The common risk factors includes:

  • Age between 30 and 40 years.
  • Males have a five times greater risk then females.
  • Participating in recreational sports involving running and/or jumping which require sudden stopping and starting.
  • Steroid injections in the ankle joint to reduce pain and inflammation  may weaken the nearby Achilles tendon and result in its rupture with minimal trauma.
  • Fluoroquinolone antibiotics like ciprofloxacin or levofloxacin may increases the chance of an Achilles tendon rupture.

Treatment of Achilles Tendon Rupture

The treatment protocol for Achilles tendon rupture depends on the severity, extent of injury, age of the patient, their level of activity and general health status. Surgery is usually the treatment of choice for young and active patients with an Achilles tendone rupture. However, non-surgical measures may be preferred for elderly patients. Rehabilitation therapy is required in both surgical and non-surgical cases.

Surgery does carry the risk of post-operative infection and possibly even nerve damage. The rupture tendon is repaired and may also be reinforced with tendons from elsewhere in the body.  Non-surgical treatment involves wearing cast or specially designed boot with a wedge at the heel area to elevate the foot and using crutches to reduce force on the affected foot.

Although studies have shown that the effectiveness of both non-surgical and surgical methods are similar to some extent, the chance of another rupture is high in patients treated by non-surgical methods. Following surgical or non surgical treatment, physical therapy is required to strengthen the leg muscles gradually. Usually it takes 4 to 6 months of treatment to regain the past level of activity.

Prevention of Achilles Tendon Rupture

As with any condition, Achilles tendon rupture is best prevented rather than treated. There are several ways in which a tendon rupture can be prevented.

  • Always stretch before exercising or playing sports. It should not be avoided prior to exercise or sports although it may not always be possible to do so for non-recreational activities.
  • Strengthen the tendon gradually. There are various exercises that can be done to target the Achilles tendon and gradually strengthen it.
  • Avoid physical activity if the tendon is not conditioned to handle this type of strain. Even adequate stretching may not be sufficient to prevent tendonitis or a tear if there extreme strain on the tendon.
  • Choose different exercises. It is important to vary exercise routines and exercise choices. This will help the tendon to slowly strengthen and prepare for different types of force.
  • Wear appropriate footwear. Good heel and arch support are important to prevent a host of foot problems. The proper running shoes are therefore important when undertaking exercises that may strain the tendon.
  • Do not ignore tendonitis. Beware of severe or recurrent Achilles tendonitis as it can progress to a rupture. Apply ice, rest the foot as much as possible and immediately switch to the correct footwear if tendonitis arises.

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