The Achilles tendon, a robust band of fibrous tissue, is located at the back of the lower leg. It connects the calf muscles, specifically the gastrocnemius and soleus, to the heel bone (calcaneus). This tendon plays a fundamental role in movement, allowing for actions such as pointing the foot downward, rising onto the toes, and pushing off the foot during walking, running, and jumping. Its ability to transmit significant force makes it a crucial component of the musculoskeletal system. A rupture signifies a tear in this strong tendon.
Defining an Achilles Rupture
An Achilles rupture is a tear in the Achilles tendon, which can be either partial or complete. A partial tear means some tendon fibers remain intact, while a complete rupture indicates the tendon has fully separated. This injury often occurs in a specific region of the tendon, typically about 2.5 to 6 centimeters (approximately 1 to 2.5 inches) above where it attaches to the heel bone. This particular section has a less robust blood supply, which affects its ability to heal and contributes to its susceptibility to injury. Understanding the distinction between partial and complete tears helps determine the nature and severity of the injury.
How an Achilles Rupture Happens
Achilles ruptures result from sudden, forceful movements that place extreme stress on the tendon. This can occur during actions like rapidly pushing off the ground, such as when accelerating in sports, or during unexpected dorsiflexion (when the foot suddenly bends upwards) while the calf muscle is contracted. Falling from a height or stepping into a hole can also lead to this injury. While these ruptures can affect anyone, certain factors increase the likelihood, including age, with a peak incidence observed in individuals aged 30 to 40. Participation in recreational sports involving sudden starts, stops, and jumps, such as soccer, basketball, and tennis, also elevates the risk. Pre-existing conditions like tendinopathy, which involves degeneration of the tendon, or the use of certain medications like fluoroquinolone antibiotics or steroid injections, can weaken the tendon and increase susceptibility to rupture.
Recognizing the Symptoms
An Achilles rupture typically presents with distinct and immediate symptoms. Individuals often report hearing a sudden “pop” or “snap” sound at the moment of injury. This is often accompanied by sharp, intense pain in the back of the ankle or lower leg, which some describe as feeling like they were kicked in the calf. Following the injury, swelling and bruising develop around the heel and ankle. Individuals experience difficulty bearing weight on the injured leg and an inability to perform actions that require pushing off the foot, such as standing on tiptoes or walking properly.
Diagnosis and Confirmation
Healthcare professionals diagnose an Achilles rupture primarily through a physical examination. During the examination, a doctor may feel a gap or defect in the area where the tendon has torn. A common diagnostic procedure is the Thompson test, where the examiner squeezes the patient’s calf muscle. If the Achilles tendon is intact, this action causes the foot to point downward (plantarflex); however, if the tendon is ruptured, the foot will not move or show significantly reduced movement. While a physical examination is highly effective for diagnosis, imaging studies like ultrasound or Magnetic Resonance Imaging (MRI) may confirm the diagnosis and assess the tear’s extent. Ultrasound is particularly sensitive and specific for detecting ruptures, while MRI can provide more detailed information about the tendon’s structure.
Treatment Options
Treatment for an Achilles rupture varies, encompassing both non-surgical (conservative) management and surgical repair. Non-surgical approaches involve immobilizing the foot and ankle in a cast or brace, often with the foot initially pointed downward (plantarflexed) to allow the tendon ends to approximate. This is followed by a gradual progression to weight-bearing and physical therapy to restore strength and range of motion. Non-surgical treatment is considered for older patients, those with lower activity demands, or individuals with contraindications to surgery.
Surgical repair stitches the torn tendon ends together. Techniques include open repair, with an incision, or minimally invasive and percutaneous methods, using smaller incisions. Surgical intervention is often preferred for younger, more active individuals who desire to return to higher levels of activity, due to a potentially lower re-rupture rate. The choice of treatment depends on several factors, including the patient’s age, activity level, the extent and location of the rupture, and overall health. Both approaches aim to facilitate healing and restore function, with rehabilitation crucial in either pathway.