Achilles tendon rupture is an injury on the back of the lower leg.
The Achilles tendon is a strong fibrous cord that links the muscles of the calf to the heel bone. Overstretching or overstraining the Achilles tendon can cause it to rupture partially or completely. The most common cases of Achilles tendon rupture occur in people who play recreational sports.
The Achilles tendon usually ruptures close to the point where the tendon attaches to the heel bone. This section receives less blood flow and thus it is more susceptible to injury.
A rupture in the Achilles tendon is identified by a snap or pop followed by an instant sharp pain in the back of the ankle and lower leg affecting the ability to walk.
The best option to repair an Achilles tendon rupture is surgery; however, nonsurgical treatment may also show improvements.
Signs and symptoms of an Achilles tendon rupture:
- Severe pain and swelling around the heel
- Inability to bend the injured foot downward or “push off” the leg when walking
- Inability to stand on the toes of the injured leg
- Snap or pop sound when the rupture occurs
In some cases it is possible not to experience symptoms of the injury.
Ruptures or tears of the Achilles tendon are frequently caused by a sudden increase of strain or stress on the tendon such as:
- Increasing the intensity of training or playing sports (mainly in sports involving jumping)
- Falling from a height
- Stepping into a hole
Risk factors for Achilles tendon rupture include:
- Age: people aged between 30 and 40 have a bigger risk of an Achilles tendon injury
- Gender: men have a five times greater risk of an Achilles tendon rupture than women.
- Sports: recreational sports that involve running and jumping or increased intensity in training increase the risk of an Achilles tendon rupture.
- Steroid injections: steroid injections are sometimes used to reduce pain and inflammation in ankle joints; however, the steroids can cause weakness in nearby tendons. In this case it may increase the risk of an Achilles tendon rupture.
- Some antibiotics: fluoroquinolone antibiotics such as ciprofloxacin or levofloxacin are also a risk factor for an Achilles tendon injury.
Rupture of the Achilles tendon can be treated with a surgical or a nonsurgical approach. The treatment varies according to age, level of activity and the severity of the injury.
- Nonsurgical treatment usually involves a leg cast or a walking boot with wedges to elevate the heel allowing the injury to heal. This approach avoids surgery related risks such as infections. However, there is a risk of a re-rupture making surgery necessary but more difficult.
- The surgical method typically involves stitching the torn tendon through an incision in the back of the lower leg. If the tendon is completely and badly torn the repair may be reinforced with other tendons. The complications of a surgical procedure include infection and nerve damage; however, smaller incisions reduce the risk of infections. Generally, younger and more active people prefer a surgical approach for an Achilles tendon rupture while older people prefer a nonsurgical treatment option. Nevertheless, both surgical and nonsurgical treatments have shown similar improvement and effectiveness.
- Rehabilitation. Following any of the treatment options (whether surgical or nonsurgical) physical therapy exercises are necessary to strengthen the leg muscles and Achilles tendon. The difference is that with nonsurgical treatment rehabilitation time may be longer; however, most people return to normal activity levels within 4 to 6 months.
The following measures may help prevent Achilles tendon injuries:
- Stretching and strengthening the calf muscles: stretching and calf-strengthening exercises can help the muscle and tendon absorb more force and make it less susceptible to injury.
- Various exercises: high-impact sports such as running, hill running and jumping can be replaced with low-impact sports such as cycling or swimming to avoid excessive stress on the Achilles tendons.
- Caution in choosing running surfaces and sports gear: running on hard or slippery surfaces should be limited or minimal. Well-fitting and proper running shoes can provide heel support during training.
- Gradual increase of training intensity: sudden increases in training intensity can cause Achilles tendon injuries or ruptures; therefore, it is recommended that training intensity should be increased by approximately 10% each week.