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Achilles Tendon Rupture

What is it?

An Achilles tendon rupture is a complete or partial tear that occurs when the tendon is stretched beyond its capacity. Forceful jumping or pivoting, or sudden accelerations of running, can overstretch the tendon and cause a tear. An injury to the tendon can also result from falling or tripping.  A rupture may also be the result of chronic disorder or degeneration of the Achilles tendon (“the straw that broke the camel’s back”). Achilles tendon ruptures are most often seen in “weekend warriors” – typically, middle-aged people participating in sports in their spare time. Less commonly, illness or medications, such as steroids or certain antibiotics, may weaken the tendon and contribute to ruptures.  

Signs and Symptoms 

A person with a ruptured Achilles tendon may experience one or more of the following:

  • Sudden pain (which feels like a kick or a stab) in the back of the ankle or calf – often subsiding into a dull ache
  • A popping or snapping sensation
  • Swelling on the back of the leg between the heel and the calf
  • Difficulty walking (esp. upstairs or uphill) and difficulty rising up on the toes

These symptoms require prompt medical attention to prevent further damage. Until the patient is able to see a doctor, the “R.I.C.E.” method should be used. (‘Complete’ Rest, Ice, Compression, and Elevation)

Diagnosis

The surgeon will examine the foot and ankle, feeling for a defect in the tendon that suggests a tear. Range of motion and muscle strength will be evaluated and compared to the uninjured foot and ankle. If the Achilles tendon is ruptured, the patient will have less strength in pushing down (as on a gas pedal) and will have difficulty rising on the toes. The diagnosis of an Achilles tendon rupture is typically clinical and straightforward and can be made through this type of examination.  In some cases, however, the surgeon may order an MRI or Ultrasound  to help evaluate the extent of the damage or for surgical planning.

Treatment 

Treatment options for an Achilles tendon rupture include surgical and non-surgical approaches. The decision of whether to proceed with surgery or non-surgical treatment is based on the severity of the rupture and the patient’s health status and activity level.

Non-Surgical Treatment 

Non-surgical treatment, which is associated with a higher rate of re-rupture, is selected for minor ruptures, less active patients, and those with medical conditions that prevent them from undergoing surgery. Non-surgical treatment involves use of a cast, walking boot, or brace to restrict motion and allow the torn tendon to heal.

Surgery

Surgery offers important potential benefits. Besides decreasing the likelihood of re-rupturing the Achilles tendon, surgery often increases the patient’s push-off strength and improves muscle function and movement of the ankle. Various surgical techniques are available to repair the rupture. The surgeon will select the procedure best suited to the patient.  

Physical Therapy 

Whether an Achilles tendon rupture is treated surgically or non-surgically, physical therapy is an important component of the healing process. Physical therapy involves exercises that strengthen the muscles and improve the range of motion of the foot and ankle.