Definition and Overview

The Achilles tendon is the thickest tendon in the human body. It is located at the back of the lower leg, about two inches above the heel bone. It connects the heel to the big calf muscles as well as controls the movement of the foot.

The tendon tightens when the calf muscles contract. This allows a person to stand on tiptoe and point the foot. It also allows a person to push off when starting a foot race.

This tendon can be damaged and break if it becomes overstretched. This results in intense, sharp pain that can prevent a person from walking properly. The injury is more common in middle-aged men who play sports that require fast, forceful motions. These include tennis, basketball, foot race, and badminton.

The injury can be treated with nonsurgical or surgical treatment. The prognosis is generally good. Many patients are able to go back to their normal activity levels after treatment.

Causes of Condition

The Achilles tendon gets damaged when it becomes overly stretched to the point of tearing. The rupture can happen during forceful motions that put significant stress on the calf muscle. An example is when a runner starts to sprint. In such scenario, the tendon does not have enough time to make adjustments to handle the intense force without injuring itself. This injury is common in people who play sports that involve a lot of jumping, running, and hopping. It can also occur due to a sudden increase in training intensity. Another possible cause is exercising without doing muscle stretching and warm up first.

The injury can also occur when the tendon becomes weak and thin. This can be due to advanced age or lack of use. This makes the tendon more prone to damage. People with tendinitis, or the inflammation of the tendon, are more prone to the injury. Other risk factors include obesity, diabetes, and arthritis. Wearing high heels on a regular basis and having flat feet also increase the risk.

Key Symptoms

A ruptured Achilles tendon causes intense pain. This can prevent a person from walking properly. The pain can be felt as soon as the tendon is torn. Some patients describe it as like “being hit by a rock or being kicked really hard.” Many patients report hearing a loud snapping or popping sound before they felt the pain. The area then swells and becomes stiff. This is followed by reduced strength and range of motion in the ankle. Often, a gap can be felt about two inches above the heel.

Patients are advised not to move the injured part. If there are inflammation and spasm, cold compresses could help. Patients must see their doctor right away. Prompt treatment can prevent the injury from getting worse.

Who to See and Types of Treatments Available

The injury is diagnosed with a physical exam. Imaging tests, such as x-rays, are often not needed. The doctor may ask the patient to try to walk and tiptoe. The patient then lies on his or her stomach and the doctor will check the area above the heel for a gap.

Treatment can involve medications and surgery. Older people and those who are less active often choose nonsurgical options. This involves immobilising the tendon. It also involves the use of medications to treat pain and swelling. This option allows patients to avoid the many risks of surgery. But recovery can take longer. The risk of re-rupture is also high with this option.

Surgery, on the other hand, is the more popular option for young patients. These include those who want to go back to their physical activities as soon as possible. The surgery can be done using traditional method in which a large incision is made in the back of the lower leg. Minimally invasive method, on the other hand, uses small incisions and miniature surgical tools. Surgery may involve sewing the ends of the tendon back together. Surgery allows the patient to return to his or her pre-injury activities sooner. However, it has risks. These include the formation of blood clots in the legs. These could be dangerous if they travel to the lungs and interrupt blood flow. Other risks are bleeding and injury to nearby nerves. There are also risks of infection and skin breakdown. Also, surgery is much more expensive than nonsurgical treatments.

Surgery is followed by physical therapy. The patient is taught how to safely perform strengthening and range-of-motion exercises. This helps speed up their recovery.

The prognosis is generally good. Many patients are able to recover fully. Many do not have lasting medical problems. Most are able to go back to their active lifestyle three to six months after surgery.

References:

  • Barfod KW, et al. Nonoperative dynamic treatment of acute Achilles tendon rupture: The influence of early weight-bearing on clinical outcome. Journal of Bone and Joint Surgery. 2014;96:1497.

  • Functional rehabilitation. American Academy of Physical Medicine and Rehabilitation. http://www.aapmr.org/about-physiatry/conditions-treatments/musculoskeletal-medicine/functional-rehabilitation.

  • Zhang H, et al. Surgical versus conservative intervention for acute Achilles tendon rupture: A PRISMA-compliant systematic review of overlapping meta-analyses. Medicine. 2015;94:1.

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