Achilles Tendon Rupture

Achilles Tendon Rupture Overview

The Achilles tendon, or tendon calcaneus, is a large ropelike band of fibrous tissue in the back of the ankle that connects the powerful calf muscles to the heel bone (calcaneus). Sometimes called the heel cord, it is the largest tendon in the human body. When the calf muscles contract, the Achilles tendon is tightened, pulling the heel. This allows you to point your foot and stand on tiptoe. It is vital to such activities as walking, running, and jumping. A complete tear through the tendon, which usually occurs about 2 inches above the heel bone, is called an Achilles tendon rupture.

Achilles Tendon Rupture Causes
The Achilles tendon can grow weak and thin with age and lack of use. Then it becomes prone to injury or rupture. Achilles tendon rupture is more common in those with preexisting tendinitis of the Achilles tendon. Certain illnesses (such as arthritis and diabetes) and medications (such as corticosteroids and some antibiotics, including quinolones such as levofloxacin [Levaquin] and ciprofloxacin [Cipro]) can also increase the risk of rupture.

  1. 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, basketball, and badminton.

  2. The injury can happen in these situations.

    1. 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.

    2. You suddenly trip or stumble, and your foot is thrust in front to break a fall, forcefully overstretching the tendon.

You fall from a significant height or abruptly step into a hole or off of a curb.

Achilles Tendon Rupture Symptoms and Signs

  1. A sudden and severe pain may be felt at the back of the ankle or calf -- often described as "being hit by a rock or shot" or "like someone stepped onto the back of my ankle."

  2. The sound of a loud pop or snap may be reported.

  3. A gap or depression may be felt and seen in the tendon about 2 inches above the heel bone.

  4. Initial pain, swelling, and stiffness may be followed by bruising and weakness.

  5. The pain may decrease quickly, and smaller tendons may retain the ability to point the toes. Without the Achilles tendon, though, this would be very difficult.

  6. Standing on tiptoe and pushing off when walking will be impossible.

A complete tear is more common than a partial tear.

Diagnosis of Achilles Tendon Rupture

  1. A physician usually can make this diagnosis with a good physical examination and history. X-rays usually are not taken.

  2. A simple test of squeezing the calf muscles while lying on your stomach should indicate if the tendon is still connected (the foot should point). This test isolates the connection between the calf muscle and tendon and eliminates other tendons that may still allow weak movement.

  3. A word of caution: Achilles tendon rupture is often misdiagnosed as a strain or minor tendon injury. Swelling and the continuing ability to weakly point your toes can confuse the diagnosis.

Ultrasound and MRI are tests that can assist in difficult diagnosis. Depending on the degree of injury, these tests can also assist in determining which treatment may be best.

Achilles Tendon Rupture Treatment

The objective of treatment is to restore normal length and tension to the tendon and allow you to do what you could do before the injury. Treatment reflects a balance between protection and early motion.

  1. Protection is necessary to allow time for healing and to prevent reinjury.

  2. Moving your foot and ankle is needed to prevent stiffness and loss of muscle tone.

  3. Treatment options are surgical or nonsurgical. The choice is controversial.

    1. Both surgical and nonsurgical treatment will require an initial period of about six weeks of casting or special braces. The cast may be changed at two- to four-week intervals to slowly stretch the tendon back to its normal length. Casting may be combined with early movement (one to three weeks) to improve overall strength and flexibility.

    2. A heel lift device and, regardless of the choice of treatment, regular physical therapy follow for the remainder of treatment.

    3. Consultation with a Podiatric surgeon will determine the treatment and follow-up that is right for you.