About two thirds of all Achilles tendon ruptures occur during sports. Total ruptures are most common in sports with stop-and-go movements, especially ball sports. The majority of patients suffered a ruptured Achilles tendon when stopping suddenly during a fast vigorous movement. Usually the Achilles tendon tears about 5 cm before it inserts into the heel bone. Particularly at risk for a tear are athletes who have already suffered from Achilles tendon problems for some time.
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).
The most common symptom of Achilles tendonitis is a sudden surge of pain in the heel and back of the ankle at the point of injury which is often described as a snapping sensation in the heel. After the injury has occurred, patients then struggle or find it near impossible to bear any weight on the affected leg. Pain can often be most prominent first thing in the morning after the injury has been rested. Swelling and tenderness is also likely to appear in the area.
The doctor may look at your walking and observe whether you can stand on tiptoe. She/he may test the tendon using a method called Thompsons test (also known as the calf squeeze test). In this test, you will be asked to lie face down on the examination bench and to bend your knee. The doctor will gently squeeze the calf muscles at the back of your leg, and observe how the ankle moves. If the Achilles tendon is OK, the calf squeeze will make the foot point briefly away from the leg (a movement called plantar flexion). This is quite an accurate test for Achilles tendon rupture. If the diagnosis is uncertain, an ultrasound or MRI scan may help. An Achilles tendon rupture is sometimes difficult to diagnose and can be missed on first assessment. It is important for both doctors and patients to be aware of this and to look carefully for an Achilles tendon rupture if it is suspected.
Non Surgical Treatment
Once a diagnosis of Achilles tendon rupture has been confirmed, a referral to an orthopaedic specialist for treatment will be recommended. Treatment for an Achilles tendon rupture aims to facilitate the torn ends of the tendon healing back together again. Treatment may be non-surgical (conservative) or surgical. Factors such as the site and extent of the rupture, the time since the rupture occurred and the preferences of the specialist and patient will be considered when deciding which treatment will be undertaken. Some cases of rupture that have not responded well to non-surgical treatment may require surgery at a later stage. The doctor will immobilise the ankle in a cast or a special hinged splint (known as a moon boot) with the foot in a toes-pointed position. The cast or splint will stay in place for 6 - 8 weeks. The cast will be checked and may be changed during this time.
A completely ruptured Achilles tendon requires surgery and up to 12 weeks in a cast. Partial tears are sometimes are treated with surgery following by a cast. Because the tendon shortens as it heals, a heel lift is used for 6 months or more after the cast comes off. Physical therapy to regain flexibility and then strength are begun as soon as the cast is off.
To help reduce your chance of getting Achilles tendon rupture, take the following steps. Do warm-up exercises before an activity and cool down exercises after an activity. Wear proper footwear. Maintain a healthy weight. Rest if you feel pain during an activity. Change your routine. Switch between high-impact activities and low-impact activities. Strengthen your calf muscle with exercises.