What Is an Achilles Tendon Rupture?
The Achilles tendon runs along the back of the lower leg and connects the gastrocnemius and soleus muscles (calf muscles) to the calcaneus (heel bone). The calf structure, including the Achilles tendon, controls the up-down motion (extension and flexion) of the foot and activates when someone pushes off the foot.
An Achilles tendon rupture usually happens to people who play sports but it can happen to anyone. A rupture is a complete tear in a tendon, where the muscle completely detaches from the bone. The Achilles tendon can also have a partial tear, where the tendon is damaged but is still in one piece.
An Achilles tendon rupture is often an acute injury, meaning there’s a definite event like a fall leading up to it. However, degeneration and wear-and-tear on the tendon may have weakened it, allowing the event to rupture the tendon. Landing from a jump, stepping into a hole and falling are main causes of Achilles tendon ruptures, as is overtraining or increasing the volume, intensity or duration of athletic training.
There are also some risk factors associated with Achilles tendon ruptures, including:
- Being age 30 to 40, the age at which Achilles tendon ruptures peak
- Being male, as men are five times more likely to rupture their Achilles tendon than women
- Certain antibiotics, such as ciprofloxacin and levofloxacin
- Obesity, which places increased stress on the tendon
- Sports that involve running, jumping and sudden starts and stops like basketball, soccer and tennis
- Steroid injections, which can weaken tendons
Pain and swelling near the heel are the main symptoms of Achilles ruptures. A loud pop often accompanies the tendon rupturing. Inability to bear weight on the injured leg and inability to stand on the toes of the injured foot are also symptoms.
A physical exam and a medical history that takes into account an increase in training or any acute injuries are usually enough to diagnose an Achilles tendon rupture. A doctor can sometimes feel a gap where the tendon ruptured. Doctors will be looking for symptoms of pain and signs of swelling near the heel of the injured foot.
Achilles tendon ruptures can be treated non-surgically, but it is important to begin bearing weight on the injured leg as soon as possible. Conservative treatment usually involves:
- Over-the-counter pain medications
If surgery is necessary, it can be done either as an open procedure—a large incision so the surgeon can see inside the area—or endoscopically, with small incisions, small tools and a flexible camera called an endoscope attached to a video monitor.
In either case, the surgery entails stitching the tendon back together. It is usually an outpatient procedure, meaning a hospital stay of 24 hours or less. The foot will have to be immobilized with a cast or boot and kept from bearing weight for at least two weeks, though some surgeons want a longer period of immobilization. After about six weeks, physical therapy can begin.
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