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Achilles Tendon Rupture by Mary Cresse

Definition

The Achilles tendon connects the calf muscles to the heel bone. A rupture occurs when there is a tearing or separation of the tendon fibers. An Achilles heel rupture leads to loss of normal function. Treatment depends on the severity of the rupture.

Achilles Tendon Rupture

Causes

Achilles tendon rupture can be caused by:

Overuse
Overstretching
Overworking an inflamed tendon
Injury from an accident or fall

Risk Factors

Factors that increase your chance of getting Achilles tendon rupture include:

Achilles tendinopathy
Recent increase in activity level
Weak or inflexible calf muscles
Previous Achilles tendon rupture
Involvement in sports that involve running, jumping, twisting, or lunging
Improper footwear
Obesity
Certain medications, such as quinolone antibiotics or corticosteroids, which weaken the tendon
Collagen vascular diseases, such as rheumatoid arthritis, lupus, scleroderma

Symptoms

Symptoms may include:

Popping or snapping noise when injury occurs
Sudden, extreme pain at back of heel
Swelling near your heel
Inability to push off from ball of foot
Inability to walk on affected leg

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. Tests may include:

MRI
Ultrasound
X-ray

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options may include the one or more of the following:

First Aid

When you are injured, apply these steps right away and seek medical help:

Stop your activity and stay off the injured foot.
Apply an ice pack. Place a towel between the ice pack and your skin.
Wrap your injured foot and ankle in elastic bandaging. Don't wrap the bandage too tight. It may cut off circulation.
Elevate your foot above your heart.

Medication

To help manage pain, your doctor may recommend:

Over-the-counter pain relievers, such as acetaminophen or non-steroidal anti-inflammatory medication (NSAIDs)
Prescription pain relievers

Surgery

Surgery is the most common treatment for this condition. The doctor makes an incision in the lower leg and sews the tendon back together. A cast, splint, walking boot, or brace is worn for 6-8 weeks. One of the benefits of surgery is that it lowers the risk of re-rupturing the tendon. Surgery may also be a better option if you are very athletic.

Non-Surgical Care

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.

Rehabilitation

During rehabilitation, you will:

Begin with range-of-motion exercise. Often these will focus on the body as a whole.
Progress to weight-bearing exercises using support devices, such as a walker or crutches.

Most people can return to normal activity in 4-6 months.

Prevention

To help reduce your chance of getting Achilles tendon rupture, take the following steps:

Do warm-up exercises before an activity. Cool down with ice to the area.
Wear proper footwear. Consider heel lifts.
Maintain a healthy weight.
Rest if you feel pain during an activity. Avoid activities that cause pain.
Change your routine. Switch between high-impact activities and low-impact activities.
Strengthen your calf muscle with exercises.

These steps can also reduce your chance of repeat injury.

RESOURCES:

American Academy of Orthopaedic Surgeons Ortho Info http://orthoinfo.org
American Podiatric Medical Association http://www.apma.org

CANADIAN RESOURCES:

Canadian Orthopaedic Foundation http://www.canorth.org
Physical Therapy Canada http://www.physicaltherapy.ca

References:

Achilles tendon rupture. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=AV0003. Updated May 12, 2012. Accessed April 25, 2013.
Achilles tendon rupture. American College of Foot and Ankle Surgeons Foot Health Facts website. Available at: http://www.foothealthfacts.org/Content.aspx?id=1363&terms=achilles%20tendon%20rupture. April 27, 2010. Accessed April 25, 2013.
Achilles tendon rupture. EBSCO Publishing DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated March 18, 2013. Accessed April 25, 2013.
Maffulli, N. Current concepts review—rupture of the Achilles tendon. JBJS. 1999;81:1019-1036.
van der Linden P, Sturkenboom C, Herings R, et al. Increased risk of Achilles tendon rupture with quinolone antibacterial use, especially in elderly patients taking oral corticosteroids. Arch Intern Med. 2003;163:1801-1807.

Last reviewed April 2013 by Rosalyn Carson-DeWitt, MD; Brian Randall, MD

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