The Achilles tendon, or tendo-Achilles, is a large, rope-like tendon that runs along the back of the leg and inserts into the calcaneus, or heel bone. The tendon is comprised of two muscles coming together, the gastrocnemius and the soleus. It is the longest tendon in the body, and functions to lift up the heel when the calf muscles contract. This is a vital function for activities such as walking, running, and jumping. When the calf muscles contract, the heel is pulled up, allowing us to point or toes. A complete tear through the tendon is known as a rupture, and most frequently occurs in the area 2-3 inches above the heel.
As a person ages, a tendon can become weak and thin. This underlying weakness of the Achilles tendon is typically present in a total rupture. Some medications such as corticosteroids or certain antibiotics, as well as illnesses such as arthritis or diabetes may also weaken the Achilles tendon.
Most frequently, Achilles tendon ruptures are seen in middle-aged male athletes. These “weekend warriors” will usually injure themselves during a sport that requires sudden bursts of activity, in particular racquet sports like tennis or squash, and basketball.
Symptoms of an Achilles tendon rupture are a sudden and severe pain in the back of the calf. There may be an audible popping or snapping sound when the tendon ruptures. Walking may still be possible, but strength of push-off with the toes will be weakened. Bruising and difficulty walking may follow the initial pain and swelling.
If you are exhibiting signs of an Achilles tendon injury, there are several tests that a doctor can perform in the office to determine the likeliness of a total rupture. The doctor may have you lie flat on your stomach, while they feel the back of your calf. A slight depression can often be felt where the tendon should be tight. Another test is to squeeze the calf muscles of the affected side. In a normal person, squeezing the calf will cause the foot to plantarflex, or point the toes. In someone with a total rupture of the Achilles tendon, this motion will be lost. A partial tear of the Achilles tendon will typically still cause the motion to occur, as some of the residual fibers are left intact.
An MRI or ultrasound may also be ordered in order to confirm the diagnosis. These imaging studies can show the foot and ankle surgeon whether or not the injury is a partial tear or complete rupture, and will help determine the extent of the injury.
Treating an Achilles tendon rupture can either be surgical or non-surgical. The non-surgical method involves placing the foot and ankle in a cast for 2-4 weeks, at which time the cast may be replaced. This allows the foot to be immobilized while the tissues heal. Casts are typically changes in order to allow slow stretching of the tendon so that it does not heal in a contracted position.
PRICE therapy also applies to Achilles tendon injuries. This involves protection (via a cast or brace), rest, ice, compression, and elevation to relieve some of the swelling.
Surgical treatment involves repairing the ruptured tendon by suturing it back together. Research has shown that in both competitive and non-competitive athletes, there is a decreased risk of re-rupture with surgical repair. There has also been some evidence to show that the time to recovery is faster using surgical repair than with non-surgical management. There are inherent risks involved with any type of surgery, however, including risks associated with anesthesia, infection, non-healing of wounds, scarring, bleeding, nerve injury, and blood clots developing in the legs.
Preventing Achilles tendon injuries, especially in older athletes, revolves around stretching the muscles before activity. This is a critical step in any workout, yet is often skipped over.
