Achilles Tendon Rupture

Achilles tendon rupture, as the name indicates, refers to the rupture or tear of the Achilles tendon, the largest tendon connecting the heel bone to calf muscles.

The tendon helps in the bending of the foot at the ankle. Rupture can be partial or complete, depending on the extent of separation of tendon fibers.

In a partial rupture, the tendon is still connected to the calf muscle while in a complete rupture, calf muscles are fully separated from the heel bone.

A person suffering from Achilles tendon rupture will not be able to stand on tiptoe. Early detection and treatment of the rupture is essential for successful healing of the tissue. 

It can be treated by non-surgical methods like the use of orthotics, or with surgery.

This condition most often affects middle-aged people who engage in weekend sports.

The symptoms of Achilles tendon rupture may develop abruptly during an activity.

The rupture sound is often characterized by a snap at the back of the heel. This may be followed by a sharp, shooting pain at the posterior part of the heel.

The pain may subside after some time, but a dull ache persists at the back of the lower leg. Some of the most common symptoms that appear after the injury include:

• A walk that resembles flat-foot
• Able to bear weight and walk, but unable to push off the ground
• Difficulty rising up on toes
• Swelling at the back of the lower leg
• Difficulty walking

If a person has any of the above mentioned symptoms of a torn tendon, medical examination is essential.

Increased stress on the tendon is the most common cause of Achilles tendon rupture. Forceful pushes off the ground can result in over straining, and thus tendon rupture.

This often happens during sporting activities like basketball, running, tennis and football. The strong contraction of the calf muscles that aid in pushing off from the ground results in tendon strain.

Achilles tendon rupture may also be caused by:

• Certain medical conditions like Cushing’s syndrome, rheumatoid arthritis, gout and systemic lupus erythematoses
• Achilles tendinitis
• Long-term use of corticosteroid medication
• Corticosteroid injections near the tendon
• Certain antibiotics
• Prior injury in the tendon

Diagnosis of Achilles tendon rupture is usually based on symptoms and physical examination. Patient may be asked to stand on tiptoe, as inability to do so indicates the chance of tendon rupture.

Thomson’s test is usually used to confirm tendon tears. In this test, the patient is asked to lie on their ventral side and bend their knees. The doctor then observes the movement of the ankle while he/she presses the calf muscles.

Imaging techniques like Ultrasound and MRI are used only when a physical examination is not enough to confirm the diagnosis.

It is important to differentiate Achilles tendon rupture from Achilles tendinitis, deep vein thrombosis, and calf muscle tears.

Ultrasound helps to assess the extent of a tear. An MRI is often used when the injury is too complex to be detected by a physical examination.

MRI helps to identify thickening and partial tendon tears as well.

Both surgical and non-surgical options are available for Achilles tendon rupture treatment. Treatment method depends on age, severity of the injury, and level of activity.

Surgical

With the surgical method, a small incision made at the back of the lower leg is used to join the torn fibers of tendon. Depending on the extent of tearing, a tendon graft may be used to join the torn part.

Surgery may result in complications like infection and nerve damage.

Non-Surgical

Using orthotics such as wedges for shoes to elevate the heel and using braces are non-surgical options for the treatment of Achilles tendon rupture.

Plaster cast provides protection and support to the tendon as it heals on its own. The plaster cast is arranged in such a way that it keeps the tendon off strain.

Physical therapy is also suggested to strengthen the muscles and tendon after treatment. Recovery time for this condition is often 4-6 months.

It is not possible to always prevent tendon rupture.

Medication

Corticosteroid medications can reduce symptoms as much as possible.

Quinolone antibiotics should be used carefully, particularly in older adults.

Personal care

Stretching and strengthening calf muscles help to avoid injury to the tendon.

As tendon rupture is caused by over straining the tendons, care should be taken when increasing activity.

Using proper sports gear and avoiding running on hard surfaces are also crucial.

There are several alternative and homeopathic remedies

Ruta is a homeopathic method often recommended for treating tendon rupture. Arnica is useful in reducing swelling.

Some of the common alternate remedies for the treatment of Achilles tendon rupture are self-massage and topical applications.

Application of castor oil to the affected site helps in relieving pain and also in reducing inflammation.

Soreness can be reduced by using vitamin-E oil or turmeric supplements.

Acupuncture is also used as an alternative treatment method for Achilles tendon rupture.

One of ways to adapt your lifestyle in coping with Achilles tendon rupture is to rest and avoid strenuous physical activity until the muscles are strengthened.

Physical therapy is helpful when trying to strengthen the muscles of a tendon. This will help to improve the range of motion at the ankle.

There are several factors like non-surgical treatments that carry the re-rupture risk and affect complications of Achilles tendon rupture.

Other complications include infection, sloughing of skin, and nerve damage.