Overview
Achilles tendon ruptures may be divided into full thickness ("total") and partial thickness ruptures. Total ruptures usually occur in formerly active athletes (average age 40) who resume sport activity after having been away from it for some time. In these cases, degenerative changes have weakened the tendon so much that sudden, forceful loading of the tendon causes it to tear. To some extent, these changes in the tendon could have been prevented by regular physical activity. In most cases, the injury mechanism is a strong activation of the posterior lower leg musculature, eccentrically overloading the tendon. A typical mechanism of injury involves pushing off hard with the weight-bearing foot while the knee is extended (e.g., running uphill) or sudden, unexpected dorsal extension of the ankle with reflex contraction of the calf musculature (e.g., falling down into a hole).
Causes
Often an Achilles rupture can occur spontaneously without any prodromal symptoms. Unfortunately the first "pop" or "snap" that you experience is your Achilles tendon rupture. Achilles tendon rupture most commonly occurs in the middle-aged male athlete (the weekend warrior who is engaging in a pickup game of basketball, for example). Injury often occurs during recreational sports that require bursts of jumping, pivoting, and running. Most often these are tennis, racquetball, squash, basketball, soccer, softball and badminton. Achilles rupture can happen in the following situations. You make a forceful push-off with your foot while your knee is straightened by the powerful thigh muscles. One example might be starting a foot race or jumping. You suddenly trip or stumble, and your foot is thrust in front to break a fall, forcefully over stretching the tendon. You fall from a significant height. It does appear that previous history of Achilles tendonitis results in a degenerative tendon, which can grow weak and thin with age and lack of use. Then it becomes prone to injury or rupture. Certain illnesses (such as arthritis and diabetes) and medications (such as corticosteroids and some antibiotics) can also increase the risk of rupture.
Symptoms
A classic sign of an Achilles tendon rupture is the feeling of being hit in the Achilles are. There is often a "pop" sound. There may be little pain, but the person can not lift up onto his toes while weight bearing.
Diagnosis
The diagnosis is usually made on the basis of symptoms, the history of the injury and a doctor's examination. 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 Thompson's 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
Pain medicines can help decrease pain and swelling. A cast may be needed for 2 months or more. Your foot will be positioned in the cast with your toes pointing slightly down. Your caregiver will change your cast and your foot position several times while the tendon heals. Do not move or put weight on your foot until your caregiver tells you it is okay. A leg brace or splint may be needed to help keep your foot from moving while your tendon heals. Heel lifts are wedges put into your shoe or cast. Heel lifts help decrease pressure and keep your foot in the best position for your tendon to heal. Surgery may be needed if other treatments do not work. The edges of your tendon may need to be stitched back together. You may need a graft to patch the tear. A graft is a piece of another tendon or artificial material.
Surgical Treatment
Surgical repair is a common method of treatment of acute Achilles rupture in North America because, despite a higher risk of overall complications, it has been believed to offer a reduced risk of rerupture. However, more recent trials, particularly those using functional bracing with early range of motion, have challenged this belief. The aim of this meta-analysis was to compare surgical treatment and conservative treatment with regard to the rerupture rate, the overall rate of other complications, return to work, calf circumference, and functional outcomes, as well as to examine the effects of early range of motion on the rerupture rate.
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!
Achilles tendon ruptures may be divided into full thickness ("total") and partial thickness ruptures. Total ruptures usually occur in formerly active athletes (average age 40) who resume sport activity after having been away from it for some time. In these cases, degenerative changes have weakened the tendon so much that sudden, forceful loading of the tendon causes it to tear. To some extent, these changes in the tendon could have been prevented by regular physical activity. In most cases, the injury mechanism is a strong activation of the posterior lower leg musculature, eccentrically overloading the tendon. A typical mechanism of injury involves pushing off hard with the weight-bearing foot while the knee is extended (e.g., running uphill) or sudden, unexpected dorsal extension of the ankle with reflex contraction of the calf musculature (e.g., falling down into a hole).
Causes
Often an Achilles rupture can occur spontaneously without any prodromal symptoms. Unfortunately the first "pop" or "snap" that you experience is your Achilles tendon rupture. Achilles tendon rupture most commonly occurs in the middle-aged male athlete (the weekend warrior who is engaging in a pickup game of basketball, for example). Injury often occurs during recreational sports that require bursts of jumping, pivoting, and running. Most often these are tennis, racquetball, squash, basketball, soccer, softball and badminton. Achilles rupture can happen in the following situations. You make a forceful push-off with your foot while your knee is straightened by the powerful thigh muscles. One example might be starting a foot race or jumping. You suddenly trip or stumble, and your foot is thrust in front to break a fall, forcefully over stretching the tendon. You fall from a significant height. It does appear that previous history of Achilles tendonitis results in a degenerative tendon, which can grow weak and thin with age and lack of use. Then it becomes prone to injury or rupture. Certain illnesses (such as arthritis and diabetes) and medications (such as corticosteroids and some antibiotics) can also increase the risk of rupture.
Symptoms
A classic sign of an Achilles tendon rupture is the feeling of being hit in the Achilles are. There is often a "pop" sound. There may be little pain, but the person can not lift up onto his toes while weight bearing.
Diagnosis
The diagnosis is usually made on the basis of symptoms, the history of the injury and a doctor's examination. 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 Thompson's 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
Pain medicines can help decrease pain and swelling. A cast may be needed for 2 months or more. Your foot will be positioned in the cast with your toes pointing slightly down. Your caregiver will change your cast and your foot position several times while the tendon heals. Do not move or put weight on your foot until your caregiver tells you it is okay. A leg brace or splint may be needed to help keep your foot from moving while your tendon heals. Heel lifts are wedges put into your shoe or cast. Heel lifts help decrease pressure and keep your foot in the best position for your tendon to heal. Surgery may be needed if other treatments do not work. The edges of your tendon may need to be stitched back together. You may need a graft to patch the tear. A graft is a piece of another tendon or artificial material.
Surgical Treatment
Surgical repair is a common method of treatment of acute Achilles rupture in North America because, despite a higher risk of overall complications, it has been believed to offer a reduced risk of rerupture. However, more recent trials, particularly those using functional bracing with early range of motion, have challenged this belief. The aim of this meta-analysis was to compare surgical treatment and conservative treatment with regard to the rerupture rate, the overall rate of other complications, return to work, calf circumference, and functional outcomes, as well as to examine the effects of early range of motion on the rerupture rate.
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!