Overview
The Achilles tendon connects the muscles in the back of your calf to your heel bone. There are two basic variations of Achilles injuries. Achilles tendonitis, and a complete tear. It?s important to know whether the Achilles is torn or not, because the treatment is very different, a torn Achilles may require surgery. Achilles tendonitis probably means rehab and rest. While tendonitis is a gradual onset of pain that tends to get worse with more activity, an Achilles tear is a sudden injury, and it feels as if you were hit or kicked in the back of the ankle. A tear usually affects your ability to walk properly. Because an Achilles tendon rupture can impair your ability to walk, it?s common to seek immediate treatment. You may also need to consult with doctors specializing in sports medicine or orthopaedic surgery.
Causes
There are a number of factors that can increase the risk of an Achilles tendon rupture, which include the following. You?re most likely to rupture your Achilles tendon during sports that involve bursts of jumping, pivoting and running, such as football or tennis. Your Achilles tendon becomes less flexible and less able to absorb repeated stresses, for example of running, as you get older. Small tears can develop in the fibres of the tendon and it may eventually completely tear. There is a very small risk of an Achilles tendon rupture if you have Achilles tendinopathy (also called Achilles tendinitis). This is where your tendon breaks down, which causes pain and stiffness in your Achilles tendon, both when you exercise and afterwards. If you take quinolone antibiotics and corticosteroid medicines, it can increase your risk of an Achilles tendon injury, particularly if you take them together. The exact reasons for this aren't fully understood at present.
Symptoms
Ankle pain and swelling or feeling like the ankle has ?given out? after falling or stumbling. A loud audible pop when the ankle is injured. Patients may have a history of prior ankle pain or Achilles tendonitis, and may be active in sports. Swelling, tenderness and possible discoloration or ecchymosis in the Achilles tendon region. Indentation above the injured tendon where the torn tendon may be present. Difficulty moving around or walking. Individual has difficulty or is unable to move their ankle with full range of motion. MRI can confirm disruption or tear in the tendon. Inability to lift the toes.
Diagnosis
A typical history as detailed above together with positive clinical examination usually will clinch the diagnosis. In an acute rupture, one can usually feel the gap in the tendon from the rupture. There may be swelling or bruising around the ankle and foot of the injured leg. With the patient lying on the tummy (prone position) with the knee flexed, the examiner should see the ankle and foot flex downwards (plantarward) when squeezing the calf muscles. If there is no movement in the ankle and foot on squeezing the calf muscle, this implies that the calf muscle is no longer attached to the heel bone due to a complete Achilles tendon rupture.
Non Surgical Treatment
There are two treatment options available which are non-operative and operative. Non-operative treatment involves the use initially of a below-knee plaster with the foot held fully bent downwards. This usually stays in place for 2 weeks then is changed for a brace(this is a boot from the knee down to the toes with Velcro straps) which should be worn day and night. The brace will be regularly altered to allow the foot to come up to a more neutral position. The brace will be on for a further 6 weeks. After the 8 weeks you will be referred for physiotherapy to regain movement and calf strength but will probably need to wear the brace during the day for a further 4 weeks. Non-operative treatment avoids the risks of surgery but the risk of the tendon re-rupturing, which normally occurs within 3 months of discarding the brace, is 10%.
Surgical Treatment
Surgery is the most common treatment for this condition. An incision is made in the lower leg and the tendon is sewn back together. A cast, splint, walking boot, or brace is worn for 6-8 weeks. One of the benefits of surgery is that it lowers the risk of re-rupturing the tendon. Surgery may also be a better option if you are athletic.
Prevention
Achilles tendon rupture can be prevented by avoiding chronic injury to the Achilles tendon (i.e. tendonitis), as well as being careful to warm up and stretch properly before physical activity. Additionally, be sure to use properly fitting equipment (e.g. running shoes) and correct training techniques to avoid this problem!
The Achilles tendon connects the muscles in the back of your calf to your heel bone. There are two basic variations of Achilles injuries. Achilles tendonitis, and a complete tear. It?s important to know whether the Achilles is torn or not, because the treatment is very different, a torn Achilles may require surgery. Achilles tendonitis probably means rehab and rest. While tendonitis is a gradual onset of pain that tends to get worse with more activity, an Achilles tear is a sudden injury, and it feels as if you were hit or kicked in the back of the ankle. A tear usually affects your ability to walk properly. Because an Achilles tendon rupture can impair your ability to walk, it?s common to seek immediate treatment. You may also need to consult with doctors specializing in sports medicine or orthopaedic surgery.
Causes
There are a number of factors that can increase the risk of an Achilles tendon rupture, which include the following. You?re most likely to rupture your Achilles tendon during sports that involve bursts of jumping, pivoting and running, such as football or tennis. Your Achilles tendon becomes less flexible and less able to absorb repeated stresses, for example of running, as you get older. Small tears can develop in the fibres of the tendon and it may eventually completely tear. There is a very small risk of an Achilles tendon rupture if you have Achilles tendinopathy (also called Achilles tendinitis). This is where your tendon breaks down, which causes pain and stiffness in your Achilles tendon, both when you exercise and afterwards. If you take quinolone antibiotics and corticosteroid medicines, it can increase your risk of an Achilles tendon injury, particularly if you take them together. The exact reasons for this aren't fully understood at present.
Symptoms
Ankle pain and swelling or feeling like the ankle has ?given out? after falling or stumbling. A loud audible pop when the ankle is injured. Patients may have a history of prior ankle pain or Achilles tendonitis, and may be active in sports. Swelling, tenderness and possible discoloration or ecchymosis in the Achilles tendon region. Indentation above the injured tendon where the torn tendon may be present. Difficulty moving around or walking. Individual has difficulty or is unable to move their ankle with full range of motion. MRI can confirm disruption or tear in the tendon. Inability to lift the toes.
Diagnosis
A typical history as detailed above together with positive clinical examination usually will clinch the diagnosis. In an acute rupture, one can usually feel the gap in the tendon from the rupture. There may be swelling or bruising around the ankle and foot of the injured leg. With the patient lying on the tummy (prone position) with the knee flexed, the examiner should see the ankle and foot flex downwards (plantarward) when squeezing the calf muscles. If there is no movement in the ankle and foot on squeezing the calf muscle, this implies that the calf muscle is no longer attached to the heel bone due to a complete Achilles tendon rupture.
Non Surgical Treatment
There are two treatment options available which are non-operative and operative. Non-operative treatment involves the use initially of a below-knee plaster with the foot held fully bent downwards. This usually stays in place for 2 weeks then is changed for a brace(this is a boot from the knee down to the toes with Velcro straps) which should be worn day and night. The brace will be regularly altered to allow the foot to come up to a more neutral position. The brace will be on for a further 6 weeks. After the 8 weeks you will be referred for physiotherapy to regain movement and calf strength but will probably need to wear the brace during the day for a further 4 weeks. Non-operative treatment avoids the risks of surgery but the risk of the tendon re-rupturing, which normally occurs within 3 months of discarding the brace, is 10%.
Surgical Treatment
Surgery is the most common treatment for this condition. An incision is made in the lower leg and the tendon is sewn back together. A cast, splint, walking boot, or brace is worn for 6-8 weeks. One of the benefits of surgery is that it lowers the risk of re-rupturing the tendon. Surgery may also be a better option if you are athletic.
Prevention
Achilles tendon rupture can be prevented by avoiding chronic injury to the Achilles tendon (i.e. tendonitis), as well as being careful to warm up and stretch properly before physical activity. Additionally, be sure to use properly fitting equipment (e.g. running shoes) and correct training techniques to avoid this problem!