The Achilles tendon is the largest and strongest tendon in the human body. The Achilles tendon connects the heel bone (calcaneus) to the muscles at the back of the calf (using gastrocnemius and soleus muscles). The synchronous function of the tendon and calf muscles is critical for activities like jumping, running, standing on the toe, and climbing stairs. When climbing stairs or running, the forces within the tendon have been measured and indicate that the structure is able to withstand at least 10 times the body weight of the individual. The function of the Achilles tendon is to help raise your heel as you walk. The tendon also assists in pushing up the toes and lifting the rear of the heel. Without an intact Achilles tendon, almost any motion with the ankle (for example, walking or running) is difficult.
Factors that may increase your risk of Achilles tendon rupture include Age. The peak age for Achilles tendon rupture is 30 to 40. Your sex. Achilles tendon rupture is up to five times more likely to occur in men than in women. Playing recreational sports. Achilles tendon injuries occur more often in sports that involve running, jumping and sudden starts and stops - such as soccer, basketball and tennis. Steroid injections. Doctors sometimes inject steroids into an ankle joint to reduce pain and inflammation. However, this medication can weaken nearby tendons and has been associated with Achilles tendon ruptures. Certain antibiotics. Fluoroquinolone antibiotics, such as ciprofloxacin (Cipro) or levofloxacin (Levaquin), increase the risk of Achilles tendon rupture.
The most common initial symptom of Achilles tendon rupture is a sudden snap at the back of the heels with intense pain. Immediately after the rupture, the majority of individuals will have difficult walking. Some individuals may have had previous complains of calf or heel pain, suggesting prior tendon inflammation or irritation. Immediately after an Achilles tendon rupture, most individuals will develop a limp. In addition, when the ankle is moved, the patient will complain of pain. In all cases, the affected ankle will have no strength. Once the Achilles tendon is ruptured, the individual will not be able to run, climb up the stairs, or stand on his toes. The ruptured Achilles tendon prevents the power from the calf muscles to move the heel. Whenever the diagnosis is missed, the recovery is often prolonged. Bruising and swelling around the calf and ankle occur. Achilles tendon rupture is frequent in elderly individuals who have a sedentary lifestyle and suddenly become active. In these individuals, the tendon is not strong and the muscles are deconditioned, making recovery more difficult. Achilles tendon rupture has been reported after injection of corticosteroids around the heel bone or attachment of the tendon. The fluoroquinolone class of antibiotics (such as ciprofloxacin [Cipro]) is also known to cause Achilles tendon weakness and rupture, especially in young children. Some individuals have had a prior tendon rupture that was managed conservatively. In such cases, recurrence of rupture is very high.
When Achilles tendon injury is suspected, the entire lower lag is examined for swelling, bruising, and tenderness. If there is a full rupture, a gap in the tendon may be noted. Patients will not be able to stand on the toes if there is a complete Achilles tendon rupture. Several tests can be performed to look for Achilles tendon rupture. One of the most widely used tests is called the Thompson test. The patient is asked to lie down on the stomach and the examiner squeezes the calf area. In normal people, this leads to flexion of the foot. With Achilles tendon injury, this movement is not seen.
Non Surgical Treatment
Achilles tendon ruptures can be treated non-operatively or operatively. Both of these treatment approaches have advantages and disadvantages. In general, younger patients with no medical problems may tend to do better with operative treatment, whereas patients with significant medical problems or older age may be best served with non-operative treatment. However, the decision of how the Achilles tendon rupture is treated should be based on each individual patient after the advantages and disadvantages of both treatment options are reviewed. It is important to realize that while Achilles tendon ruptures can be treated either non-operatively or operatively, they must be treated. A neglected Achilles tendon rupture (i.e. one where the tendon ends are not kept opposed) will lead to marked problems of the leg in walking, which may eventually lead to other limb and joint problems. Furthermore, late reconstruction of non-treated Achilles tendon rupture is significantly more complex than timely treatment.
This injury is often treated surgically. Surgical care adds the risks of surgery, there are for you to view. After the surgery, the cast and aftercare is typically as follows. A below-knee cast (from just below the knee to the tips of the toes) is applied. The initial cast may be applied with your foot positioned in a downward direction to allow the ends of the tendon to lie closer together for initial healing. You may be brought back in 2-3 week intervals until the foot can be positioned at 90 degrees to the leg in the cast. The first 6 weeks in the cast are typically non-weight bearing with crutches or other suitable device to assist with the non-weight bearing requirement. After 6 weeks in the non-removable cast, a removable walking cast is started. The removable walking cast can be removed for therapy, sleeping and bathing. The period in the removable walking cast may need to last for an additional 2-6 weeks. Your doctor will review a home physical therapy program with you (more on this program later) that will typically start not long after your non-removable cast is removed. Your doctor may also refer you for formal physical therapy appointments. Typically, weight bearing exercise activities are kept restricted for at least 4 months or more. Swimming or stationary cycling activities may be allowed sooner. Complete healing may take 12 months or more.
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