What Is It?
Tendons are the structures that connect muscle to bone. They are key in giving us the ability to move. The Achilles tendon is the largest tendon in our body and connects to the two muscles that make up our calf. The Achilles tendon extends from this complex, crosses the talus (the ankle bone) and attaches itself to the calcaneus (the heel bone). Together they form a unit that allows the calf muscle to pull the foot down and is essential for our mobility. Like muscle, tendons are made up of tiny fibers that come together and form a bigger structure (you can imagine it like the weaves of thread that make up a rope). An Achilles tendon rupture occurs when these fibers tear and can result in partial or complete separation of the tendon from the muscle.
Most of the time a tear occurs as a result of sports injury, such as over extension or exertion during a quick and sudden movement. The typical tell-tale sign is a sudden sharp pain, snap, and/or a distinct popping sound at the site of the injury. However, pre-existing conditions can also lead to the gradual wear of the tendon resulting in a tear. The typical Achilles tendon rupture usually happens 4 to 6 centimeters above the point where the tendon joins the heel bone. Another type of Achilles rupture is a heel rupture. In this scenario, the tendon is either torn away from the heel bone or is detached along with a fragment of the bone itself. This is known as an avulsion fracture and results when a bone fragment breaks away from the main body.
Indications
Other indications for a rupture include bruising and swelling, as well as weakness in the effected foot. Your doctor will perform tests to confirm if your Achilles tendon is ruptured or not. One test known as the Thompson test is used to confirm separation of the tendon from it’s muscle. By having the patient laying down flat on their stomach with their feet bent toward the ceiling, a doctor can squeeze the calf in such a manor to illicit a response from the foot. A positive test for an Achilles tendon rupture will result in no such reflex response. An MRI or an ultrasound can also be ordered to confirm the presence of a rupture and the extent of the damage. Clinical and radiographic assessment is always necessary in confirming a diagnosis.
Treatment Options
An Achilles tendon rupture can be treated conservatively by flexing the foot downward and casting it in that position, allowing the two ends to be rejoined and healed over time. This process usually takes at least three months, but could take more. Afterwards the patient would have to undergo a period of physical therapy to regain motion and strength. Although it is possible in some occasions for an Achilles tendon to heal without the need for surgery, many healthcare professionals advise surgical intervention for a more optimal recovery. Patients treated conservatively typically don’t regain full strength in their tendon. They also run the risk of re-rupture. Surgeons can reattach the tendon by suturing the torn pieces together. This usually results in a quicker recovery time and a stronger tendon and is advised for younger or more active individuals. The goal surgically is to restore both length and tension to the tendon. It is important to note that though outcomes may be more optimal for surgical intervention, the repaired tendon will always be weaker than the opposite side. Surgery also runs its own risks, which could make some patients favor a more conservative treatment. Thus it is up to the patient and their own expectations in deciding a treatment course.
Prognosis
If a patient chooses surgery, they will be placed either into a cast, boot or splint until the tendon has enough time to heal. All procedures tend to be ambulatory, meaning that patients will be discharged to go home on the same day. They will require a non-weight bearing device such as a knee walker for mobility. No matter the course of treatment, physical therapy is essential to optimize recovery. Depending on the procedure and type of immobilization used, recovery times can vary. Patients will begin with motion training exercises a few weeks after surgery and work their way up to strength training. Recovery times can typically take anywhere from 4 to 6 months.
Disclaimer: The information compiled in this guide was taken from sources made available to the public and from consultation with orthopedic surgeons. We are not medical professionals and do not regard ourselves as experts. Always listen to the instructions given by your doctor first and foremost. However, we encourage patient education and recommend that you research your injury further. Your medical institution website may have further useful information. Otherwise please check our list sources for more detailed reading.
Sources
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