The Achilles tendon is the largest and strongest tendon in the body. It functions to help control the foot when walking and running. Ruptures of the Achilles tendon commonly occur in individuals in their 30s and 40s. This age group is affected because these patients are still quite active, but over time their tendons tend to become stiffer and gradually weaken. These ruptures usually occur when an athlete loads the Achilles in preparation to pushing off. This can occur when suddenly changing directions, starting to run, or preparing to jump. These ruptures occur because the calf muscle generates tremendous force through the Achilles tendon in the process of propelling the body. Patients will feel a sharp intense pain in the back of their heel. Patients often initially think that they were ?struck in the back of the heel? and then realize that there was no one around them. After the injury, patients will have some swelling. If they can walk at all, it will be with a marked limp. It is very rare that a rupture of the Achilles is partial. However, a painful Achilles tendonitis or a partial rupture of the calf muscle (gastrocnemius) as it inserts into the Achilles can also cause pain in this area. The pain of an Achilles rupture can subside quickly and this injury may be misdiagnosed in the Emergency Department as a sprain. Important clues to the diagnosis are an inability to push off with the foot and a visible or palpable defect just above the heel bone in the back of the leg.
The most common cause of a ruptured Achilles' tendon is when too much stress is placed through the tendon, particularly when pushing off with the foot. This may happen when playing sports such as football, basketball or tennis where the foot is dorsiflexed or pushed into an upward position during a fall. If the Achilles' tendon is weak, it is prone to rupture. Various factors can cause weakness, including corticosteroid medication and injections, certain diseases caused by hormone imbalance and tendonitis. Old age can also increase the risk of Achilles' tendon rupture.
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.
A staggering 20%-30% of Achilles tendon ruptures are missed. Thompson (calf squeeze) test is 96% sensitive and 93% sensitive. Unfortunately, some health practitioners fail to perform this simple clinical test. Ultrasound examination or an MRI can confirm an Achilles tendon rupture.
Non Surgical Treatment
Non-surgical treatment of Achilles tendon rupture is usually reserved for patients who are relatively sedentary or may be at higher risk for complications with surgical intervention (due to other associated medical problems). This involves a period of immobilization, followed by range of motion and strengthening exercises; unfortunately, it is associated with a higher risk of re-rupture of the tendon, and possibly a less optimal functional outcome.
There are two different types of surgeries; open surgery and percutaneous surgery. During an open surgery an incision is made in the back of the leg and the Achilles tendon is stitched together. In a complete or serious rupture the tendon of plantaris or another vestigial muscle is harvested and wrapped around the Achilles tendon, increasing the strength of the repaired tendon. If the tissue quality is poor, e.g. the injury has been neglected, the surgeon might use a reinforcement mesh (collagen, Artelon or other degradable material). In percutaneous surgery, the surgeon makes several small incisions, rather than one large incision, and sews the tendon back together through the incision(s). Surgery may be delayed for about a week after the rupture to let the swelling go down. For sedentary patients and those who have vasculopathy or risks for poor healing, percutaneous surgical repair may be a better treatment choice than open surgical repair.