r10 Achilles Tendon Rupture
A rupture of the Achilles tendon is a complete or partial tear of the tendon that connects the calf muscles to the heel bone. Usually this occurs just above where the tendon attaches to the heel bone, although it can happen anywhere along the tendon.
Achilles tendons may tear when people who are usually sedentary and have weakened tendons engage in strenuous activity. Tears can also occur in people who have had previous chronic injury to their Achilles tendons. Tendon injuries can be caused by overuse, improper stretching habits, worn-out or improperly fitting shoes, and poor biomechanics (flat-feet). The risk of tendon rupture is also increased with the use of quinolone antibiotics (e.g. ciprofloxacin, Levaquin).
Our Approach to Achilles Tendon Rupture
The treatment for a torn Achilles tendon is usually surgery. In this procedure, the surgeon stitches the ends of the torn tendon together. If the tendon is badly damaged, the surgeon may use another tendon to reinforce the repair.
Achilles Tendon Rupture Signs and Symptoms
Patients who suffer an acute rupture of the Achilles tendon often report hearing a “pop” or “snap.” Patients usually have severe pain in the back of the leg near the heel, sometimes accompanied by swelling. Additionally, because the function of the Achilles tendon is to enable plantarflexion (bending the foot downward), patients often have difficulty walking or standing up on their toes.
Achilles Tendon Rupture Diagnosis
Other less serious causes of pain in the back of the lower leg include Achilles tendonitis or bursitis. To distinguish between these possibilities, your physician will take a thorough history and examine your lower leg to look for signs of a rupture. The presence of a defect in the tendon that can be felt, evidence of weakness with plantarflexion, and a history consistent with Achilles tendon rupture are usually sufficient for diagnosis. Your physician may also perform a “Thompson test,” which consists of squeezing the calf muscles of the affected leg. With an intact Achilles tendon, the foot will bend downward; however, with a complete rupture of the tendon, the foot will not move. In cases where the diagnosis is equivocal, your physician may order an MRI of the leg to diagnose a rupture of the Achilles tendon.
Achilles Tendon Rupture Treatments
Unlike other diseases of the Achilles tendon such as tendonitis or bursitis, Achilles tendon rupture is usually treated with surgical repair. The surgery consists of making a small incision in the back part of the leg, and using sutures to re-attach the two ends of the ruptured tendon. Depending on the condition of the ends of the ruptured tendon and the amount of separation, the surgeon may use other tendons to reinforce the repair. After the surgery, the leg will be immobilized for 6-8 weeks in a walking boot, cast, brace, or splint. Following this time period, patients work with a physical therapist to gradually regain their range of motion and strength. Return to full activity can take quite a long time, usually between 6 months and 1 year.
Non-surgical treatment of Achilles tendon rupture is usually reserved for patients who are relatively sedentary or may be at higher risk for complications with surgical intervention (due to other associated medical problems). This involves a period of immobilization, followed by range of motion and strengthening exercises; unfortunately, it is associated with a higher risk of re-rupture of the tendon, and possibly a less optimal functional outcome.
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