Overview
A tendon is a band of tissue that connects a muscle to a bone. The Achilles tendon runs down the back of the lower leg and connects the calf muscle to the heel bone. Also called the heel cord, the Achilles tendon facilitates walking by helping to raise the heel off the ground. The Achilles tendon is at the back of the heel. It can be ruptured by sudden force on the foot or ankle. If your Achilles tendon is ruptured you will be unable to stand on tiptoe, and will have a flat-footed walk. It is important to diagnose and treat this injury as soon as possible, to help promote healing. Treatment involves wearing a plaster cast or brace (orthosis) for several weeks, and possibly having an operation.
Causes
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.
Symptoms
Patients with an Achilles tendon rupture will often complain of a sudden snap in the back of the leg. The pain is often intense. With a complete rupture, the individual will only be ambulate with a limp. Most people will not be able to climb stairs, run, or stand on their toes. Swelling around the calf may occur. Patients may often have had a sudden increase in exercise or intensity of activity. Some patients may have had recent corticosteroid injections or use of fluoroquinolone antibiotics. Some athletes may have had a prior injury to the tendon.
Diagnosis
The doctor may look at your walking and observe whether you can stand on tiptoe. She/he may test the tendon using a method called Thompsons test (also known as the calf squeeze test). In this test, you will be asked to lie face down on the examination bench and to bend your knee. The doctor will gently squeeze the calf muscles at the back of your leg, and observe how the ankle moves. If the Achilles tendon is OK, the calf squeeze will make the foot point briefly away from the leg (a movement called plantar flexion). This is quite an accurate test for Achilles tendon rupture. If the diagnosis is uncertain, an ultrasound or MRI scan may help. An Achilles tendon rupture is sometimes difficult to diagnose and can be missed on first assessment. It is important for both doctors and patients to be aware of this and to look carefully for an Achilles tendon rupture if it is suspected.
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.
Surgical Treatment
There are a variety of ways to repair an Achilles tendon rupture. The most common method is an open repair. This starts with an incision made on the back of the lower leg starting just above the heel bone. After the surgeon finds the two ends of the ruptured tendon, these ends are sewn together with sutures. The incision is then closed. Another repair method makes a small incision on the back of the lower leg at the site of the rupture. A series of needles with sutures attached is passed through the skin and Achilles tendon and then brought out through the small incision. The sutures are then tied together. The best surgical technique for your Achilles rupture will be determined by your orthopaedic foot and ankle surgeon.
Prevention
To help prevent an Achilles tendon injury, it is a good practice to perform stretching and warm-up exercises before any participating in any activities. Gradually increase the intensity and length of time of activity. Muscle conditioning may help to strengthen the muscles in the body.
A tendon is a band of tissue that connects a muscle to a bone. The Achilles tendon runs down the back of the lower leg and connects the calf muscle to the heel bone. Also called the heel cord, the Achilles tendon facilitates walking by helping to raise the heel off the ground. The Achilles tendon is at the back of the heel. It can be ruptured by sudden force on the foot or ankle. If your Achilles tendon is ruptured you will be unable to stand on tiptoe, and will have a flat-footed walk. It is important to diagnose and treat this injury as soon as possible, to help promote healing. Treatment involves wearing a plaster cast or brace (orthosis) for several weeks, and possibly having an operation.Causes
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.
Symptoms
Patients with an Achilles tendon rupture will often complain of a sudden snap in the back of the leg. The pain is often intense. With a complete rupture, the individual will only be ambulate with a limp. Most people will not be able to climb stairs, run, or stand on their toes. Swelling around the calf may occur. Patients may often have had a sudden increase in exercise or intensity of activity. Some patients may have had recent corticosteroid injections or use of fluoroquinolone antibiotics. Some athletes may have had a prior injury to the tendon.
Diagnosis
The doctor may look at your walking and observe whether you can stand on tiptoe. She/he may test the tendon using a method called Thompsons test (also known as the calf squeeze test). In this test, you will be asked to lie face down on the examination bench and to bend your knee. The doctor will gently squeeze the calf muscles at the back of your leg, and observe how the ankle moves. If the Achilles tendon is OK, the calf squeeze will make the foot point briefly away from the leg (a movement called plantar flexion). This is quite an accurate test for Achilles tendon rupture. If the diagnosis is uncertain, an ultrasound or MRI scan may help. An Achilles tendon rupture is sometimes difficult to diagnose and can be missed on first assessment. It is important for both doctors and patients to be aware of this and to look carefully for an Achilles tendon rupture if it is suspected.
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.
Surgical Treatment
There are a variety of ways to repair an Achilles tendon rupture. The most common method is an open repair. This starts with an incision made on the back of the lower leg starting just above the heel bone. After the surgeon finds the two ends of the ruptured tendon, these ends are sewn together with sutures. The incision is then closed. Another repair method makes a small incision on the back of the lower leg at the site of the rupture. A series of needles with sutures attached is passed through the skin and Achilles tendon and then brought out through the small incision. The sutures are then tied together. The best surgical technique for your Achilles rupture will be determined by your orthopaedic foot and ankle surgeon.
Prevention
To help prevent an Achilles tendon injury, it is a good practice to perform stretching and warm-up exercises before any participating in any activities. Gradually increase the intensity and length of time of activity. Muscle conditioning may help to strengthen the muscles in the body.
