The Achilles tendon, a robust band of tissue located at the back of the lower leg, connects the calf muscles to the heel bone. This powerful tendon allows for actions like pushing off the ground, standing on tiptoes, and jumping. An Achilles tendon tear is a serious injury that can significantly impact daily activities and movement. Understanding the nature of this injury is a step toward proper management and recovery.
Understanding an Achilles Tendon Tear
The Achilles tendon is the largest and strongest tendon in the human body, capable of withstanding forces up to ten times an individual’s body weight during activities. A tear occurs when the fibers of this tendon are stretched beyond their capacity, leading to a partial or complete separation. A partial tear involves some damage to the tendon fibers, while a complete rupture signifies a full separation of the tendon. The location of the tear often occurs about 2-3 inches above the heel bone, though it can happen closer to the heel or higher in the leg.
Recognizing the Signs of a Tear
An Achilles tendon tear presents with immediate symptoms. Many report hearing a sudden “pop” or snapping sound at the back of the ankle, sometimes feeling as if kicked in the calf. This is followed by sharp, sudden pain near the heel. Swelling and bruising are also common. Weakness when attempting to push off the foot or stand on tiptoes may also occur.
The Reality of Walking With a Tear
Walking normally after an Achilles tendon tear is generally not possible, becoming extremely difficult or impossible, especially with a complete rupture. While some with a partial tear may manage to bear some weight or hobble, this is not a stable or safe way to move. The loss of connection between the calf muscles and the heel bone means the powerful push-off mechanism necessary for walking is severely compromised. This results in instability and pain with any attempt at weight-bearing.
Continuing to put weight on a torn Achilles tendon carries risks and can worsen the injury. Bearing weight on a partially torn tendon can enlarge the tear, potentially turning it into a complete rupture. It can also prevent the tendon from healing properly, leading to chronic pain and instability. Without proper treatment and immobilization, the tendon may heal in a lengthened position, which can permanently impair ankle function and make future activities like running or jumping difficult.
Immediate Steps After an Injury
If an Achilles tendon tear is suspected, immediate action is necessary to minimize further damage and prepare for medical evaluation. The first step is to stop all activity that puts stress on the injured leg. Applying the RICE protocol (Rest, Ice, Compression, Elevation) can help manage initial symptoms.
Rest involves avoiding any weight-bearing activities. Apply ice to the back of the ankle for 15-20 minutes every two to three hours to reduce swelling and pain. Compression, such as an elastic bandage, helps limit swelling, and elevating the leg above the heart aids in reducing fluid accumulation. Seek immediate medical attention by visiting an urgent care center or emergency room.
Medical Diagnosis and Treatment Options
A medical professional will diagnose an Achilles tendon tear through a physical examination. During the examination, the surgeon may perform a calf squeeze test (Thompson test), where squeezing the calf muscle of a healthy leg causes the toes to point down, but if the tendon is torn, there will be weak or no movement in the foot. The surgeon may also feel for a gap in the tendon. While special tests like ultrasound or MRI scans may be used, they are not always necessary for diagnosis.
Treatment approaches vary and involve either surgical repair or non-surgical management. Non-surgical treatment begins with immobilizing the injured leg in a splint or special boot, requiring the use of crutches or a wheelchair to avoid weight-bearing. Over time, the brace is adjusted to allow increased movement, followed by gradual weight-bearing and specific strengthening exercises, guided by a physical therapist. Surgical repair options, such as open repair or minimally invasive techniques, involve stitching the torn ends of the tendon back together. The choice between surgical and non-surgical treatment depends on factors such as the severity of the tear, the patient’s age, activity level, and overall health.