Sports Medicine

Achilles Tendon Rupture

Anatomy

The foot is a complex, flexible structure that contains bones, joints, and more than 100 muscles, tendons and ligaments, all working together to enable movement and balance. The foot is divided into three sections, the forefoot, the midfoot and the hindfoot, which includes the ankle and heel. The heel bone (calcaeus) is the largest bone in the foot.

Tendons are bands of tissue that attach muscle to bone. The largest tendon in the body is the Achilles tendon. The Achilles tendon connects the calf muscles to the heel bone, allowing movement such as running, jumping and standing on the toes.

Description

An Achilles tendon rupture is a complete or partial tear that occurs when the Achilles tendon is stretched beyond its capacity.

Causes

Forceful jumping or pivoting, or sudden accelerations of running, can overstretch the tendon and cause a tear. An injury to the tendon can also result from falling or tripping. Achilles tendon ruptures are most often seen in "weekend warriors"—typically, middle-aged people participating in sports in their spare time.

Symptoms

A person with a ruptured Achilles tendon may experience one or more of the following:

• Sudden pain in the back of the ankle or calf (like being kicked or stabbed) that often subsides into a dull ache.
• A popping or snapping sensation.
• Swelling on the back of the leg, between the heel and calf.
• Difficulty walking (especially upstairs or uphill) and rising up on the toes.

Nonsurgical Treatment

Treatment options for an Achilles tendon rupture include surgical and nonsurgical approaches, depending on the severity of the rupture and the patient's health status and activity level. Nonsurgical treatment is typically selected for minor ruptures, less active patients, and those with medical conditions that prevent them from undergoing surgery. Treatment involves use of a cast, walking boot, or brace that restricts motion and allows the torn tendon to heal. Nonsurgical treatment is generally associated with a higher rate of rerupture.

Surgery

Surgery offers potential benefits over nonsurgical treatment, including a decreased likelihood of rerupturing the Achilles tendon. Following surgical treatment, patients often experience an increase in push-off strength and improvements in muscle function and ankle movement. As with any surgery, there are some risks, and these vary from person to person. Complications are typically minor, treatable and unlikely to affect your final outcome. Your orthopaedic surgeon will speak to you prior to surgery to explain any potential risks and complications that may be associated with your procedure.

Recovery

Most patients experience good results from surgery, however, the amount of damage to the tendon is an important factor in recovery. The greater the amount of tendon involved, the longer the recovery period. Physical therapy also plays a significant part in the recovery process. If appropriate, a foot and ankle conditioning program may be recommended.