The Achilles tendon, or calcaneal tendon, is a large ropelike band of fibrous tissue in the back of the ankle that connects the powerful calf muscles to the heel bone (calcaneus). Sometimes called the heel cord, it is the largest tendon in the human body. When the calf muscles contract, the Achilles tendon is tightened, pulling the heel. This allows you to point your foot and stand on tiptoe. It is vital to such activities as walking, running, and jumping. A complete tear through the tendon, which usually occurs about 2 inches above the heel bone, is called an Achilles tendon rupture.
Ruptured Achilles tendons may result from falling from a height or down a hole. Increasing training intensity abruptly, boosting distance, frequency or duration by more than 10% a week. Failing to stretch before and after exercise. Repetitive training, especially uphill running. Deyhydration, which causes cramping and tightness in the calves. Taking antibiotics. Improper footwear. Explosive movements in competitive sports like basketball, soccer or track & field.
Symptoms of an Achilles tendon rupture include sensation that someone or something has hit the back of the calf muscle, sudden pain, pain when walking, weakness in the leg, which is particularly noticeable when trying to push off while walking and there is not sufficient strength to do so.
If an Achilles tendon rupture is suspected, it is important to consult a doctor straight away so that an accurate diagnosis can be made and appropriate treatment recommended. Until a doctor can be consulted it is important to let the foot hang down with the toes pointed to the ground. This prevents the ends of the ruptured tendon pulling any farther apart. The doctor will take a full medical history, including any previous Achilles tendon injuries and what activity was being undertaken at the time the present injury occurred. The doctor will also conduct a physical examination and will check for swelling, tenderness and range of movement in the lower leg and foot. A noticeable gap may be able to be felt in the tendon at the site of the rupture. This is most obvious just after the rupture has occurred and swelling will eventually make this gap difficult to feel. One test commonly used to confirm an Achilles tendon rupture is the Thomson test. For this test the patient lies face down on an examination table. The doctor then squeezes the calf muscles; an action that would normally cause the foot to point like a ballerina (plantar flexion). When a partial rupture has occurred the foot's ability to point may be decreased. When a complete rupture has occurred, the foot may not point at all. Ultrasound scanning of the Achilles tendon may also be recommended in order to assist with the diagnosis.
Non Surgical Treatment
Not every torn Achilles tendon needs an operation. Recent studies have shown that even a conservative treatment, i.e. immobilizingt the leg can lead to satisfactory healing successes. This requires, however, that the patient is fitted with a cast (immobilization splint) and/or a special boot for a period of approximately 6 - 8 weeks. After that, the boot must be worn during the day for about two more weeks. An intensive physiotherapy will start after about six weeks to train the calf muscles so that the initial coordination can be restored. Running training on flat ground can be started again after another 10 - 12 weeks. Studies show that the danger of a recurring torn tendon is higher after a conservative treatment opposed to an operative treatment. Depending on the type of treatment, about 10 - 15 percent of those affected can expect at some point to again suffer from a tear of the Achilles tendon. Moreover, in the non-operated cases, we see more often a significant permanent weakness of the footprint, particularly restricting the ability to participate in sports.
Some surgeons feel an early surgical repair of the tendon is beneficial. The surgical option was long thought to offer a significantly smaller risk of re-rupture compared to traditional non-operative management (5% vs 15%). Of course, surgery imposes higher relative risks of perioperative mortality and morbidity e.g. infection including MRSA, bleeding, deep vein thrombosis, lingering anesthesia effects, etc.