Complete Achilles Tendon Rupture

The Achilles Tendon is a cord like fibrous tissue that links the heel bone (calcaneus) to the muscles of the lower leg (the calf muscles/gastroc-soleus muscles).

The calf muscles are one of the most powerful muscle group in the body and the Achilles tendon is the thickest and strongest tendon in the body.

Contracting the calf muscles pulls the Achilles tendon, which pushes the foot downward (plantarflex). This allows one to stand on the toes, walk, run and jump.

Each Achilles tendon is subject to a person’s entire body weight with each step. Depending upon speed, stride, terrain and additional weight being carried or pushed, each Achilles tendon may be subject to up to 3-12 times a person’s body weight during a sprint or push off.

Why does a complete Achilles tendon rupture happen?

Achilles tendon ruptures are most likely to occur in sports requiring sudden stretching, such as sprinting and racquet sports. Achilles tendon ruptures can happen to anyone, but are most likely to occur to middle age athletes who have not been training or who have been doing relatively little training.

Common sporting activities related to Achilles tendon rupture include: badminton, tennis, squash.

Less common sporting activities that can lead to Achilles tendon rupture include: tae kwon do, soccer, etc.

Occasionally the sufferer may have a history of having had pain in the Achilles tendon in the past and was treated with steroid injection to around the tendon by a doctor. This can lead to weakening of the tendon predisposing it to complete rupture.

Certain antibiotics taken by mouth or by intravenous route can weaken the Achilles tendon predisposing it to rupture. An example would be the quinolone group of antibiotics. An common example is Ciprofloxacin (or Ciprobay).

What are the symptoms?

It happens suddenly, often without warning. There is often a popping sound when the tendon ruptures. The patient usually feel as if someone has kicked their heel from the rear, only to turn around to find nobody there.

There is acute pain and swelling in the back of the heel due to bleeding from the tendon rupture.

The patient will have difficulty walking as they cannot toe off without pain. This causes them to walk with a limp.

What To Do Next?

Ice the Achilles tendon to reduce the swelling. Get a pair of crutches for walking and put less weight on the injured leg.

Then go and see a doctor.

Achilles Tendon Rupture with Gap Seen

How to Diagnose a Complete Achilles Tendon Rupture?

A typical history as detailed above together with positive clinical examination usually will clinch the diagnosis.

In an acute rupture, one can usually feel the gap in the tendon from the rupture.

There may be swelling or bruising around the ankle and foot of the injured leg.

With the patient lying on the tummy (prone position) with the knee flexed, the examiner should see the ankle and foot flex downwards (plantarward) when squeezing the calf muscles. If there is no movement in the ankle and foot on squeezing the calf muscle, this implies that the calf muscle is no longer attached to the heel bone due to a complete Achilles tendon rupture.

Investigations

If the diagnosis is in doubt, a bed-side ultrasound scan will be performed. This will usually allow a visual confirmation of the torn tendon as well as the size of the gap.

MRI scans are usually not needed unless the diagnosis is not clear or if the patient gave a history of having been injured for a few weeks or months.

Torn Achilles Tendon

Treatment

Treatment for ruptured Achilles tendon is surgical repair.

Surgery involves a 3 to 5 cm incision over the back of the ankle centred over the torn tendon.

After surgical repair, the ankle is casted with the foot plantar-flexed (pointing downwards) for 3 weeks. This cast is changed at 3 weeks after the surgery with the foot in a neutral plantigrade position. The cast is finally removed at 6 weeks after the surgery.

Physiotherapy is recommended from the 6th week onwards in order for the patient to regain flexibility and strength in the operated heel.

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