A torn or ruptured Achilles tendon is simply no fun at all. This essential cord of strong, fibrous material attaches the heel bone to the calf muscles and is used in just about every movement, from walking and running to jumping and standing on your tip-toes. It also helps bend the foot downwards at the ankle. As the strongest tendon in the body, the Achilles can withstand a force of about 1,000 pounds. About 7 out of every 100,000 people will suffer from a ruptured Achilles at some point in time, with over 80% of these injuries occurring during a recreational sports activity. Athletes have a 24% chance of tearing their Achilles, but competitive runners have a 40 to 50% chance of Achilles tendon rupture during their lifetime.
Inflammation/strain of the tendon is usually caused by overuse, for example, frequent jumping in volleyball, netball or basketball. It is often also caused by a sudden increase in certain types of training, such as hill sprinting or track running, particularly when running in spikes. Tendinopathy can also be associated with ageing. Our ability to regenerate damaged tissue decreases as we age and the quality of the tendon deteriorates. However, the better news is that sensible training can actually strengthen all our soft tissue (tendons, ligaments and muscle). Tightness in the calf muscles will demand greater flexibility of the tendon, which inevitably results in overuse and injury. Biomechanically, the tightness can reduce the range of dorsiflexion (toe up position) in the ankle, which increases the amount and duration of pronation. This problem is known as overpronation.* This reduces the ability of the foot to become a rigid lever at push off and places more lateral and linear forces through the tendon. This imbalance can translate into altered rotation of the tibia (shin bone) at the knee joint and, in turn, produce compensatory rotation at the hip joint with subsequent injuries to the shin, knee and hip. Pronation is part of the natural movement of the subtalar joint in the foot. It allows ?eversion? (turning the sole outwards), dorsiflexion and abduction (pointing the toes out to the side). Pronation is a normal part of the gait cycle, when walking and running, and it helps to provide shock absorption in the foot. When pronation is excessive, the foot has a tendency to roll inward more than normally acceptable. One sign of overpronation is greater wear on the inside of your running shoes than on the midsole. Lack of stability around the ankle joint can also be a contributory factor, as recurrent ankle sprains appear to be associated with a high incidence of Achilles tendonopathy. Wearing shoes that don?t fit or support the foot properly can be a major contributing cause of Achilles tendon injury.
Patients with an Achilles tendon rupture frequently present with complaints of a sudden snap in the lower calf associated with acute, severe pain. The patient reports feeling like he or she has been shot, kicked, or cut in the back of the leg, which may result in an inability to ambulate further. A patient with Achilles tendon rupture will be unable to stand on his or her toes on the affected side.
A physician usually can make this diagnosis with a good physical examination and history. X-rays usually are not taken. A simple test of squeezing the calf muscles while lying on your stomach should indicate if the tendon is still connected (the foot should point). This test isolates the connection between the calf muscle and tendon and eliminates other tendons that may still allow weak movement. A word of caution, Achilles tendon rupture is often misdiagnosed as a strain or minor tendon injury. Swelling and the continuing ability to weakly point your toes can confuse the diagnosis. Ultrasound and MRI are tests that can assist in difficult diagnosis. Depending on the degree of injury, these tests can also assist in determining which treatment may be best.
Non Surgical Treatment
Treatment for a ruptured Achilles tendon often depends on your age, activity level and the severity of your injury. In general, younger and more active people often choose surgery to repair a completely ruptured Achilles tendon, while older people are more likely to opt for nonsurgical treatment. Recent studies, however, have shown fairly equal effectiveness of both operative and nonoperative management. Nonsurgical treatment. This approach typically involves wearing a cast or walking boot with wedges to elevate your heel, which allows your torn tendon to heal. This method avoids the risks associated with surgery, such as infection. However, the likelihood of re-rupture may be higher with a nonsurgical approach, and recovery can take longer. If re-rupture occurs, surgical repair may be more difficult.
Surgery could allow for a quicker healing time. The procedure generally involves making an incision in the back of your lower leg and stitching the torn tendon together. Depending on the condition of the tissue, the repair may be reinforced with other tendons. As with any surgery, the main complication is the risk for infection, however, this risk is reduced by using smaller incisions.
To prevent Achilles tendonitis or rupture, the following tips are recommended. Avoid activities that place an enormous stress on the heel (for example, uphill running or excessive jumping). Stop all activity if there is pain at the back of the heel. If pain resumes with one particular exercise, another exercise should be selected. Wear proper shoes. Gradually strengthen calf muscles with sit-ups if prior episodes of Achilles tendonitis have occurred. Always warm up with stretching exercises before any activity. Avoid high-impact sports if prior episodes of Achilles tendon injury.