Rupture of the Achilles tendon is a common injury in healthy, young, active individuals. The rupture is typically spontaneous and most commonly observed in individuals in between 24-45 years of age. The majority have had no prior history of pain or previous injury to the heel. In the majority of cases, rupture of the Achilles tendon occurs just a few centimeters above the heel bone. Common causes of Achilles tendinitis or rupture include advanced age, poor conditioning, and overexertion during exercise. In most cases, the individual rapidly performs activity like running or standing on the toes, which generates intense force on the tendon, leading to rupture. Achilles tendon rupture is often described as an abrupt break with instantaneous pain that is felt in the foot or heel area. The pain may radiate along the back of the leg and is often intense. Generally, walking may be difficult and the foot may drag. Most individuals claim that they felt like they were kicked in that area or even shot at. These symptoms lead to a suspicion of rupture of the Achilles tendon. Sometimes the tendon does not fully rupture but only a partial tear develops. The partial tear can also present with pain, and if not recognized, can rapidly develop into a full-blown rupture. In the majority of cases, the Achilles tendon rupture occurs just above the heel, but it may occur anywhere along the length of the tendon.
Achilles tendon rupture occurs in people that engage in strenuous activity, who are usually sedentary and have weakened tendons, or in people who have had previous chronic injury to their Achilles tendons. Previous injury to the tendon can be caused by overuse, improper stretching habits, worn-out or improperly fitting shoes, or poor biomechanics (flat-feet). The risk of tendon rupture is also increased with the use of quinolone antibiotics (e.g. ciprofloxacin, Levaquin).
Although it’s possible to have no signs or symptoms with an Achilles tendon rupture, most people experience pain, possibly severe, and swelling near your heel. An inability to bend your foot downward or “push off” the injured leg when you walk. An inability to stand up on your toes on the injured leg. A popping or snapping sound when the injury occurs. Seek medical advice immediately if you feel a pop or snap in your heel, especially if you can’t walk properly afterward.
Diagnosis of Achilles tendon rupture is not difficult. Usually, the diagnosis is obvious after examination of the ankle and performing some easy foot maneuvers (such as attempting to stand on the toes). When an Achilles tendon rupture occurs, there is often clinical confirmation of tenderness and bruising around the heel. A gap is felt when the finger is passed over the heel area, where the rupture has developed. All individuals with a full-blown rupture of the tendon are unable to stand on their toes. There is no blood work required in making a diagnosis of Achilles tendon rupture. The following are three common radiological tests to make a diagnosis of Achilles tendon rupture. Plain X-rays of the foot may reveal swelling of the soft tissues around the ankle, other bone injury, or tendon calcification. Ultrasound is the next most commonly ordered test to document the injury and size of the tear. For a partial tear of the Achilles tendon, the diagnosis is not always obvious on a physical exam and hence an ultrasound is ordered. This painless procedure can make a diagnosis of partial/full Achilles tendon rupture rapidly. Ultrasound is a relatively inexpensive, fast, and reliable test. MRI is often ordered when diagnosis of tendon rupture is not obvious on ultrasound or a complex injury is suspected. MRI is an excellent imaging test to assess for presence of any soft-tissue trauma or fluid collection. More importantly, MRI can help detect presence of tendon thickening, bursitis, and partial tendon rupture. However, MRI is expensive and is not useful if there is any bone damage.
Non Surgical Treatment
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. 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.
Surgery could allow for a quicker healing time. The procedure generally involves making an incision in the back of your lower leg and stitching the torn tendon together. Depending on the condition of the tissue, the repair may be reinforced with other tendons. As with any surgery, the main complication is the risk for infection, however, this risk is reduced by using smaller incisions.