Achilles Tendon Rupture & Degeneration

The Achilles tendon, the largest and strongest tendon in the body, is a fibrous cord that connects the muscles in the back of your calf to your heel bone and helps control the foot when walking and running. The tendon is subject to a load stress two – four times body weight during normal walking and up to eight times body weight when running, therefore, regaining normal Achilles tendon function is critical.

Achilles tendon rupture is an injury that generally occurs in individuals in their 30’s and 40’s which affects the back of your lower leg due to a partial or complete break in the tendon.

Overview

Achilles tendon rupture is an injury that affects the back of your lower leg when there is a partial or complete break in the tendon. Achilles tendon rupture occurs most commonly in individuals in their 30s and 40s that participate in recreational sports that require sudden acceleration or changes in direction such as basketball, tennis, sprinting, etc. These ruptures occur because the calf muscle generates extreme force through the Achilles tendon in the process of pushing the body forward.

Symptoms

It is rare to have no signs and symptoms with an Achilles tendon rupture, but it is possible. Most people experience the following symptoms:

  • Feeling like the back of the leg or heel was "struck by something" at the time of injury
  • A snapping or popping sound at the time of injury
  • An inability to walk without limping following the injury
  • Mild or severe pain and swelling near the heel
  • An inability to bend the foot down or push off the injured leg when walking
  • An inability to stand on the toes of the injured leg

The pain associated with an Achilles tendon rupture can subside quickly and can lead to a misdiagnosis at the ER as simply a sprain, but if there is a visible defect just above the heel bone and the inability to push off with the foot persists, an Achilles tendon rupture is a likely cause.

Diagnosis

The diagnosis of an Achilles tendon rupture is generally made entirely on physical examination. The physician will examine the lower leg for any swelling or tenderness. In many cases, the physician might notice a significant defect or be able to feel a gap in your tendon, especially if it has ruptured completely.

The main test to detect a full Achilles tendon rupture is the Thompson test which examines the integrity of the Achilles tendon by squeezing the calf. The patient lies on his/her stomach with the feet hanging over the end of the exam table. The physician will then squeeze the calf muscle to see if the foot automatically flexes; if it does, the Achilles tendon is intact, however, if it does not move, it's probably ruptured.

If there is any question about the extent of your Achilles tendon injury, your doctor may order an ultrasound or MRI scan to take a closer look and determine the proper course of treatment.

Treatment

Achilles tendon ruptures can be treated non-operatively as well as operatively and there are advantages and disadvantages to both approaches. Treatment typically depends on the patient's age, activity level, and the severity of the injury. In general, younger patients who are more active and have no major medical problems tend to choose surgery to repair a completely ruptured Achilles tendon, whereas older patients or patients with significant medical issues are more likely to opt for non-operative treatment. Regardless of the approach taken, timely treatment of an Achilles tendon rupture is critical as a neglected Achilles tendon rupture can lead to other problems of the leg which can further lead to limb and joint problems.

Non-Operative Treatment of an Achilles Tendon Rupture - This approach generally involves wearing a cast or a boot with wedges to elevate your heel with relative immobilization and limited or no weight bearing, allowing your torn tendon to heal. The main advantage with a non-operative approach is that without an incision, the risks associated with surgery such as infection or proper wound healing is completely avoided. However, the risk of re-rupture is higher and recover can take more time.

Operative Treatment of an Achilles Tendon Rupture - This approach involves making an incision in the back of the lower leg and suturing the torn tendon together. Depending on the severity of the rupture, the repair may be reinforced with neighboring tendons. The main disadvantage of an open repair of the Achilles tendon rupture is the potential for a scar or improper healing resulting in an infection that is difficult to eradicate. However, physicians take strong measures to ensure a low risk of infection. The advantages outweigh the risks as the rate of re-rupture is significantly lower, the recovery is much faster and the patients can usually experience complete return to normal range of motion.

Recovery

Regardless of the treatment approach taken, patients go through a rehabilitation program which includes physical therapy exercises that are crucial to strengthen your leg muscle and Achilles tendon. Each patient is unique, so the therapy program will vary based on his/her level of pain, extent of injury, and desired level of activity. Typically, most patients return to normal activities within three to four months, however, athletic activities and the return of strength can take up to a year; this is something to discuss with the physician as well as the physical therapist.

Disclaimer

CALL 911 IMMEDIATELY IF YOU ARE HAVING A MEDICAL EMERGENCY!

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