Ankle > Achilles Tendon Rupture

 What is the Achilles Tendon?                                                                                     

You can feel your Achilles tendon beneath the skin on the back of your ankle. It is a fibrous band that connects your calf muscles to your heel bone (calcaneus), which allows you to lift your heel off the ground.

When you rupture your Achilles tendon, the tendon tears completely across. When you flex your calf muscles, they no longer pull up on your heel bone. A ruptured Achilles tendon causes you to lose stability in your ankle joint.

Causes

The most common cause of an Achilles tendon rupture is a sudden upward movement of your ankle, called a dorsiflexion, while your calf muscle is contracted. When the calf muscle and Achilles tendon contract, they try to force your foot downward. A rupture can happen if the outside forces pushing up on your foot are too great for your Achilles tendon to withstand. Pushing off on your foot, such as starting a sprint, when your foot is bent downward (a position called plantar flexion) also is a common way to rupture your Achilles tendon. Achilles tendon ruptures occur most frequently in sports such as basketball, tennis, soccer, and other activities that impose forceful ankle movements. The injury is more common in weekend warrior-type athletes between their early 30s and late 40s. If you have not been engaging in activities regularly, your Achilles tendon may be tight and slightly inflexible. You could put yourself at risk for many sports injuries, including an Achilles rupture, if you suddenly increase the intensity of your workouts or sports activities.

Considerations

Most studies have shown that Achilles tendon ruptures treated in a cast have a higher re-rupture rate compared to those treated operatively. The injury also may cause you to lose plantar flexion strength, which is the strength you need to bend your foot downward. If you are middle aged or elderly and relatively inactive, an Achilles rupture can be treated in a cast knowing that you might have some lack of push-off power, or plantar flexion. Operating on your Achilles has a risk of infection or wound problems in the back of the heel or calf that is not an issue with cast treatment. Physicians consider your age and activity level when deciding whether you are a candidate for surgery. A younger patient involved in competitive sports or who is very active may be a candidate for early surgical intervention. The links to the left describe treatments for Achilles tendon ruptures in detail.

Orthopedic Evaluation

There usually are three parts to an orthopedic evaluation: medical history, a physical examination, and tests that your doctor may order.

MEDICAL HISTORY

Your physician likely will ask about your activities, since they may have caused the Achilles rupture. You may be asked when the soreness or pain began, and if you have had any prior Achilles tendon injuries, your physician will ask about the treatments you have tried in the past. You may be asked how long your Achilles tendon took to begin swelling, and whether you were able to walk after you noticed the pain. Physicians also typically ask about other conditions, such as diabetes and allergies, and medications currently being taken. You also may be asked about your physical and athletic goals – information that will help decide what treatment might be best for you in achieving those goals.

Physical Exam                                                                                                                 [top]

Physicians usually pinch your Achilles tendon with their fingers to test for swelling and pain. If the tendon itself is inflamed, your physician may be able to feel warmth and swelling around the tissue, or, in chronic cases, lumps of scar tissue. You will probably be asked to walk around the exam room so your physician can examine your stride. To check for complete rupture of the tendon, your physician may perform the Thompson test. Your physician squeezes your calf; if your Achilles is not torn, the foot will point downward. If your Achilles is torn, the foot will remain in the same position.

Tests

Should your physician require a closer look, these imaging tests may be performed:

   X-rays taken from different angles may be used to rule out other problems, such as ankle fractures. MRI (magnetic resonance imaging) uses magnetic waves to create pictures of your ankle that let physicians look more clearly at the tendons surrounding your ankle joint.