The Achilles tendon is a strong, cord-like ligament that connects the muscles at the back of the calf, the soleus and the gastrocnemuis muscles, to the calcaneus (heel bone). It is the thickest and strongest tendon in the human body.
There is a zone just above the attachment of the Achilles tendon on the calcaneus called the “avascular zone” where the blood supply is very poor, inhibiting the body’s ability to repair injury and making this a common site for tendon injury and rupture. The tendon can also tear at the musculotendinous junction, the area higher in the calf where the muscle fibers from the calf begin to transition to tendon fibers of the Achilles. Tears in this area can be more difficult to repair becasue the musclular portion does not hold stitches as well as the tendon.
Causes of Achilles Ruptures
Ruptures are often caused by a sudden increase in stress on the tendon. For example, quickly increasing intensity of exercise or sports participation, a fall, or a step into a hole could cause a rupture. Rupture usually occurs about 6 centimeters above the heel because the lack of blood flow in this area predisposes it to injury and hampers healing.
Risk factors for Achilles tendon rupture include:
• Sex – males are up to five times more likely than women to rupture the Achilles tendon
• Age – most people who rupture the Achilles tendon are in their 30s or 40s
• Specific Sports – soccer, basketball, and tennis, which involve sudden starts and stops, have more Achilles injuries
• Prior steroid injections around the tendon have been associated with a weakening of the Achilles tendon
• Medical conditions such as gout, rheumatoid arthritis, and kidney failure can increase the risk of rupture
Symptoms of an Achilles Rupture
Symptoms of an Achilles rupture typically include:
• Pain and swelling near the heel
• A gap in the Achilles tendon near the heel that can be felt
• Inability to bend the foot downward
• Inability to stand on the toes on the injured leg
• A popping sound when the injury occurs
Diagnosis of an Achilles Rupture
During the physical exam, the doctor will check for tenderness and swelling. Often the doctor will be able to feel the gap where a rupture occurs. You may also be asked to try standing on your toes or flexing your foot. An MRI may be ordered to assess the extent of the injury.
The best treatment for an Achilles tendon rupture generally depends on age, activity level, and severity of the injury.
Non-surgical treatment typically means wearing a cast or walking boot for a period of time.
Surgery generally involves stitching the torn tendon together. If the rupture is severe, the tendon may be reinforced with tissue from another tendon.
Risks of surgery include:
- Nerve damage
- Blood clots
The repaired tendon will be protected in a splint and then a walking boot with special heel wedges for several weeks. Generally physical therapy will be utilized to return strength and range of motion. Most people will return to their former level of activity within four to six months.
- Will my Achilles tendon tear heal without surgery?
Studies have shown that the Achilles tendon will often heal without surgery, but the quality of the healed tendon may not be as good as with surgical repair. The re-rupture rates are higher with non-operative treatment. If you are active and otherwise health, the results are generally better with operative repair.
If you have more questions, please call my office at 502-394-6341.