Achilles tendon ruptures commonly occur in athletic individuals in their 30s and 40s while performing activities that require sudden acceleration or changes in direction (ex. basketball, tennis, etc.). Patients usually describe a sharp pain in their heel region almost as if they were struck in the back of the leg. The diagnosis of an acute Achilles tendon rupture is made on clinical examination as x-rays will reveal the ankle bones to be normal. The Achilles is the largest and strongest tendon in the body. It is subject to 2-3 times body weight during normal walking so regaining normal Achilles tendon function is critical. Achilles tendon ruptures can be successfully treated non-operatively, or operatively, but they must be treated. Surgical treatment leads to a faster recovery and a lower rate of re-rupture. However, surgery can be associated with very serious complications such as an infection or wound healing problems. For this reason non-operative treatment may be preferable in many individuals, especially those patients with diabetes, vascular disease, and those who are long-term smokers.
As with any muscle or tendon in the body, the Achilles tendon can be torn if there is a high force or stress on it. This can happen with activities which involve a forceful push off with the foot, for example, in football, running, basketball, diving, and tennis. The push off movement uses a strong contraction of the calf muscles which can stress the Achilles tendon too much. The Achilles tendon can also be damaged by injuries such as falls, if the foot is suddenly forced into an upward-pointing position, this movement stretches the tendon. Another possible injury is a deep cut at the back of the ankle, which might go into the tendon. Sometimes the Achilles tendon is weak, making it more prone to rupture. Factors that weaken the Achilles tendon are corticosteroid medication (such as prednisolone), mainly if it is used as long-term treatment rather than a short course. Corticosteroid injection near the Achilles tendon. Certain rare medical conditions, such as Cushings syndrome, where the body makes too much of its own corticosteroid hormones. Increasing age. Tendonitis (inflammation) of the Achilles tendon. Other medical conditions which can make the tendon more prone to rupture, for example, rheumatoid arthritis, gout and systemic lupus erythematosus (SLE) - lupus. Certain antibiotic medicines may slightly increase the risk of having an Achilles tendon rupture. These are the quinolone antibiotics such as ciprofloxacin and ofloxacin. The risk of having an Achilles tendon rupture with these antibiotics is actually very low, and mainly applies if you are also taking corticosteroid medication or are over the age of about 60.
It happens suddenly, often without warning. There is often a popping sound when the tendon ruptures. The patient usually feel as if someone has kicked their heel from the rear, only to turn around to find nobody there. There is acute pain and swelling in the back of the heel due to bleeding from the tendon rupture. The patient will have difficulty walking as they cannot toe off without pain. This causes them to walk with a limp.
Laboratory studies usually are not necessary in evaluating and diagnosing an Achilles tendon rupture or injury, although evaluation may help to rule out some of the other possibilities in the differential diagnosis. Plain radiography. Radiographs are more useful for ruling out other injuries than for ruling in Achilles tendon ruptures. Ultrasonography of the leg and thigh can help to evaluate the possibility of deep venous thrombosis and also can be used to rule out a Baker cyst, in experienced hands, ultrasonography can identify a ruptured Achilles tendon or the signs of tendinosis. Magnetic resonance imaging (MRI). MRI can facilitate definitive diagnosis of a disrupted tendon and can be used to distinguish between paratenonitis, tendinosis, and bursitis.
Non Surgical Treatment
If you suspect a total rupture of the achilles tendon then apply cold therapy and compression and seek medical attention as soon as possible. In most cases surgery is required and the sooner this takes place the higher the chances of success. If the injury is left longer than two days then the chances of a successful outcome decrease. Cold and compression can also be applied throughout the rehabilitation phase as swelling is likely to be an issue with such a serious injury.
Referral to a surgeon for open or percutaneous repair of the tendon is often necessary, followed by an immobilisation period. Functional bracing and early mobilisation are becoming more widely used postoperatively. There is no definitive protocol for this and it may differ, depending on the surgeon. Operative treatment has a reduced chance of re-rupture compared with conservative treatment (3.5% versus 12.6%) and a higher percentage of patients returning to the same level of sporting activity (57% versus 29%). The patient's desired functional outcome and comorbidities that affect healing will be factors in the decision to operate.