• Achilles Tendon Rupture

    (Rupture, Achilles Tendon; Severely Torn Achilles Tendon)

    Definition

    The Achilles tendon connects the calf muscles to the heel bone. A rupture, or tear, can occur when the tendon is overstretched. This injury is very painful. You may hear a popping or snapping noise when the tendon is torn.
    Achilles Tendon Rupture
    Achilles Tendon Rupture
    Copyright © Nucleus Medical Media, Inc.

    Causes

    Achilles tendon rupture can be caused by:
      Too much stress placed on the tendon, common during:
      • Running, especially on hills, stairs, and hard surfaces
      • Lunging, jumping, twisting (eg, basketball, football, rugby)
    • Weakened tendon that has not fully healed from previous injury, use of medication, or disease
    • Overworking an inflamed tendon
    • Having an accident where the tendon is cut or mangled (less common)

    Risk Factors

    These factors increase your chance of developing Achilles tendon rupture:
    • Having weak or inflexible calf muscles
    • Being overweight
    • Wearing improper footwear
    • Having flat feet
    • Not warming up properly before exercising, and not cooling down properly afterwards
    • Not stretching properly
    • Participating in certain activities, such as basketball, football, and rugby
    • Using tendon-relaxing medications, which may lessen the pain and cause you to overuse the tendon
    • Previously rupturing the Achilles tendon
    • Current use of quinolone antibiotics or corticosteroids, which can weaken tendons
    • Collagen vascular disease (eg, rheumatoid arthritis , lupus , scleroderma )
    • Smoking
    Tell your doctor if you have any of these risk factors.

    Symptoms

    If you have any of these symptom, do not assume it is due to Achilles tendon rupture. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:
    • Popping or snapping noise when injury occurs
    • Sudden, extreme pain at back of heel
    • Swelling near your heel (severe with full rupture)
    • Inability to push off from ball of foot
    • Inability to walk on affected leg

    Diagnosis

    Your doctor will ask about your symptoms and medical history. You will also have a physical exam. Tests may include:
    • MRI scan —a test that uses magnetic waves to make pictures of structures in the body; useful in viewing tendons and joints
    • Ultrasound—a test that uses sound waves to exam the tendon; may not be able to show the difference between a complete tear and a partial tear
    • Thompson test—a method to test the tendon by squeezing the calf muscle
    • X-ray —a test that uses radiation to take a picture of structures inside the body, especially bones

    Treatment

    Talk with your doctor about the best treatment plan for you. Upon injury, stop the activity. You may need to see a doctor right way. Treatment options include the following:

    First Aid

    For first aid after the injury, remember the acronym “RICE”:
    • Rest—Get off foot right away.
    • Ice—Place a cold pack on the area.
    • Compress—Lightly wrap foot with compression bandage.
    • Elevate—To limit pain and swelling, elevate your foot.

    Medication

    To relieve pain and reduce swelling, you may want to take:
      Nonsteroidal anti-inflammatory medications (NSAIDS), such as:
      • Acetaminophen
      • Ibuprofen

    Surgery

    Surgery is the most common treatment for this condition. The doctor makes an incision in the lower leg. Then, she sews the tendon back together. A cast , splint, walking boot, or brace is worn for 6-8 weeks. One of the benefits of surgery is that it lowers the risk of re-rupturing the tendon. Surgery may also be a better option if you are very athletic.

    Non-Surgical Care

    The other option is to allow your tendon to heal without surgery. In this case, you also need to wear a cast, splint, walking boot, or brace for 6-8 weeks. A heel lift decreases force on the tendon. It may take longer to heal, though. You also may have different exercises to do. If you are less active or have a chronic illness that prevents surgery, this option may be better for you.

    Rehabilitation

    During rehabilitation, you will:
    • Begin with range-of-motion exercise . Often these will focus on the body as a whole.
    • Progress to weight-bearing exercises, using support devices (eg, walker or crutches).
    Most people can return to normal activity in 4-6 months.

    Prevention

    To help reduce your chance of getting Achilles tendon rupture, take the following steps:
    • Do warm-up exercises before an activity. Cool down with ice to the area.
    • Wear proper footwear. Consider heel lifts.
    • Stretch before exercising.
    • Maintain a healthy weight .
    • Rest if you feel pain during an activity. Avoid activities that cause pain.
    • Change your routine. Switch between high-impact activities (eg, running ) and low-impact activities (eg, walking ).
    • Do exercises that strengthen your calf muscle.
    These steps can also reduce your chance of repeat injury.

    RESOURCES

    American Academy of Orthopaedic Surgeons http://www.aaos.org/

    American Podiatric Medical Association http://www.apma.org/

    CANADIAN RESOURCES

    Canadian Orthopaedic Foundation http://www.canorth.org/

    Physical Therapy Canada http://www.physicaltherapy.ca/

    References

    Achilles tendon rupture. EBSCO Publishing DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated October 2008. Accessed November 4, 2008.

    Achilles tendon rupture. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/achilles-tendon-rupture/DS00160/DSECTION=treatments-and-drugs . Updated July 2008. Accessed November 4, 2008.

    Achilles tendon rupture. Private Healthcare UK website. Available at: http://www.privatehealth.co.uk/diseases/arthritic-bone-muscle/achilles-tendon-rupture/ . Accessed November 4, 2008.

    American Physical Therapy Association. Taking Care of Your Foot and Ankle . American Physical Therapy Association website. Available at: http://www.apta.org/AM/Images/APTAIMAGES/ContentImages/ptandbody/foot/footankle.pdf . Published 1996. Accessed November 2, 2008.

    Ibuprofen. EBSCO Publishing Patient Education Reference website. http://www.ebscohost.com/healthLibrary/ . Accessed November 2, 2008.

    Maffulli, N. Current concepts review—rupture of the Achilles tendon. JBJS. 1999;81:1019-1036.

    Stedman TL. Stedman’s Medical Dictionary. 28th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2005: B9;B13

    Stretanski MF. Frontera: Essentials of Physical Medicine and Rehabilitation. Philadelphia, PA; Hanley and Belfus; 2002: chap 72.

    van der Linden P, Sturkenboom C, Herings R, et al. Increased risk of Achilles tendon rupture with quinolone antibacterial use, especially in elderly patients taking oral corticosteroids. Arch Intern Med. 2003;163:1801-1807.

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