About achilles tendon rupture

What is achilles tendon rupture?

The most common initial symptom of Achilles tendon rupture is a sudden snap at the back of the heels with intense pain. Immediately after the rupture, the majority of individuals will have difficult walking.

  • Some individuals may have had previous complains of calf or heel pain, suggesting prior tendon inflammation or irritation.
  • Immediately after an Achilles tendon rupture, most individuals will develop a limp. In addition, when the ankle is moved, the patient will complain of pain. In all cases, the affected ankle will have no strength.
  • Once the Achilles tendon is ruptured, the individual will not be able to run, climb up the stairs, or stand on his toes. The ruptured Achilles tendon prevents the power from the calf muscles to move the heel.
  • Whenever the diagnosis is missed, the recovery is often prolonged.
  • Bruising and swelling around the calf and ankle occur.
  • Achilles tendon rupture is frequent in elderly individuals who have a sedentary lifestyle and suddenly become active. In these individuals, the tendon is not strong and the muscles are deconditioned, making recovery more difficult.
  • Achilles tendon rupture has been reported after injection of corticosteroids around the heel bone or attachment of the tendon. The fluoroquinolone class of antibiotics (such as ciprofloxacin [Cipro]) is also known to cause Achilles tendon weakness and rupture, especially in young children.
  • Some individuals have had a prior tendon rupture that was managed conservatively. In such cases, recurrence of rupture is very high.

Function of Achilles tendon

The Achilles tendon is the largest and strongest tendon in the human body. The Achilles tendon connects the heel bone (calcaneus) to the muscles at the back of the calf (using gastrocnemius and soleus muscles). The synchronous function of the tendon and calf muscles is critical for activities like jumping, running, standing on the toe, and climbing stairs.

When climbing stairs or running, the forces within the tendon have been measured and indicate that the structure is able to withstand at least 10 times the body weight of the individual.

The function of the Achilles tendon is to help raise your heel as you walk. The tendon also assists in pushing up the toes and lifting the rear of the heel. Without an intact Achilles tendon, almost any motion with the ankle (for example, walking or running) is difficult.

Blood supply of Achilles tendon

The Achilles tendon receives its blood supply from only one blood vessel (the posterior tibial artery). This blood vessel has many small branches, which supply the entire tendon. However, the blood vessels just above the heel do become narrow with age, and this increases the risk of rupture. The Achilles tendon in young people has adequate blood supply, leading to a strong and flexible tendon, which is less prone to rupture. With advanced age, the Achilles tendon is easily irritated and inflamed and thus prone to rupture.

What is an Achilles tendon rupture?

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.

It is important to know that pain at the back of the heel is not always due to Achilles tendon rupture. It may be due to bursitis (fluid accumulation in the heel due to repeated irritation) and tendonitis (pain along the Achilles tendon due to constant friction and irritation). The above disorders tend to improve with use of pain medications and rest, whereas Achilles tendon rupture requires surgery and/or a cast.

The exact number of people who develop Achilles tendon injury is not known, because many people with mild tendonitis or partial tear do not seek medical help. It is believed to be more common in men but with the recent participation of women in athletics, the incidence of Achilles tendon injury is also increasing in this population. Overall, injury to the Achilles tendon is by far most common in the athlete/active individual.

What are the symptoms for achilles tendon rupture?

Although it's possible to have no signs or symptoms with an Achilles tendon rupture, most people have:

  • The feeling of having been kicked in the calf
  • Pain, possibly severe, and swelling near the heel
  • An inability to bend the foot downward or "push off" the injured leg when walking
  • An inability to stand on the toes on the injured leg
  • A popping or snapping sound when the injury occurs

When to see your doctor

Seek medical advice immediately if you hear a pop in your heel, especially if you can't walk properly afterward.

What are the causes for achilles tendon rupture?

Your Achilles tendon helps you point your foot downward, rise on your toes and push off your foot as you walk. You rely on it virtually every time you walk and move your foot.

Rupture usually occurs in the section of the tendon situated within 2 1/2 inches (about 6 centimeters) of the point where it attaches to the heel bone. This section might be prone to rupture because blood flow is poor, which also can impair its ability to heal.

Ruptures often are caused by a sudden increase in the stress on your Achilles tendon. Common examples include:

  • Increasing the intensity of sports participation, especially in sports that involve jumping
  • Falling from a height
  • Stepping into a hole

What are the treatments for achilles tendon rupture?

In general, for complete tear of the tendon, surgery is recommended. For partial tears, nonsurgical treatment is recommended. However, the selection of treatment depends on the patient, age, level of activity, and other risk factors.

What are the risk factors for achilles tendon rupture?

Factors that may increase your risk of Achilles tendon rupture include:

  • Age. The peak age for Achilles tendon rupture is 30 to 40.
  • Sex. Achilles tendon rupture is up to five times more likely to occur in men than in women.
  • Recreational sports. Achilles tendon injuries occur more often during sports that involve running, jumping, and sudden starts and stops — such as soccer, basketball and tennis.
  • Steroid injections. Doctors sometimes inject steroids into an ankle joint to reduce pain and inflammation. However, this medication can weaken nearby tendons and has been associated with Achilles tendon ruptures.
  • Certain antibiotics. Fluoroquinolone antibiotics, such as ciprofloxacin (Cipro) or levofloxacin (Levaquin), increase the risk of Achilles tendon rupture.
  • Obesity. Excess weight puts more strain on the tendon.

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