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Achilles tendon injuries can occur suddenly and can be a cause for concern. Pain in the back of the ankle can indicate an Achilles tendon injury. Whether the Achilles tendon is torn or ruptured will determine how it is treated as well as the recovery process.
In this article, you will learn the causes, symptoms, and treatment of Achilles tendon tears and ruptures.
What Is an Achilles Tendon Tear and Achilles Tendon Rupture?
The terms “Achilles tendon tear” and “Achilles tendon rupture” are often used interchangeably, however they mean different things.
An Achilles tendon tear refers to an injury where the tendon fibers are damaged, but not completely separated. This damage can be minor, causing only partial tearing, and is often the result of overuse or strain.
Given the important role of the Achilles tendon in various physical movements (such as lifting the heel, aiding in forward propulsion while walking, and facilitating the plantar flexion of the ankle) Achilles tears can result in discomfort and reduced mobility.
An Achilles tendon rupture is a more severe injury, where the tendon fibers are completely torn apart, or “ruptured”.
This usually occurs in the watershed region of the tendon, a thinner and poorer blood-supplied area located 2-6cm above the back of the heel. Due to the poor blood supply in the area, ruptures are more common in this area.
Both a torn Achilles and a rupture of the tendon cause pain and loss of strength, but a rupture can result in a more significant loss of function.
Both conditions require immediate medical attention for diagnosis and treatment.
What Causes Ruptures in the Achilles?
Achilles tendon ruptures occur due to forced plantarflexion (foot pointing in a downwards direction) of the heel during sports, overstretching of the tendon, and even direct trauma like falling from a height.
Any sport that requires sudden movements and pivoting can cause a rupture of the Achilles tendon. These sports include badminton, tennis, basketball, racquetball, etc. These sports place intense strain on the tendon.
Achilles tendon ruptures commonly occur in the third-fifth decade of life and are seen more often in males. In right-handed individuals, Achilles tendon injuries are commonly seen in the left leg.
Achilles tendon ruptures often occur in individuals who participate in sports occasionally (weekend warriors). It is more often seen in individuals who do not train properly before intense physical activity.
Medical conditions (like diabetes and rheumatoid arthritis) and medications (fluoroquinolone) can weaken the Achilles tendon and increase its susceptibility to rupturing.
Certain foot structures, like having overly flat feet or high arched feet, can place strain on the tendon and increase its chance of rupture.
What Causes a Heel Cord Tear?
Overuse and tightness in the calf muscles can cause the Achilles tendon to become diseased and weakened. This will then develop into a tear.
An Achilles tendon tear is present inside of the tendon itself, due to chronic degeneration and inflammation of the Achilles tendon.
What Are the Symptoms of Both Injuries?
- A sudden and distinct sensation of a “snap” or “pop” during injury.
- Palpable defect or gap in the back of the leg at the site of rupture.
- Feeling as if someone kicked you in the back of the leg or ankle.
- Severe pain in the back of the leg, ankle, or heel.
- Swelling and bruising in the ankle area.
- Difficulty or inability to flex the ankle up and down.
- Trouble walking due to pain and weakness.
- Gradual pain and swelling in the Achilles tendon area, typically in the case of an intrasubstance tear.
- A sudden onset of pain with a tearing sensation, typically in cases of partial ruptures.
- Swelling and bruising in the ankle area.
- Weakness when trying to flex the ankle up and down.
- Pain and difficulty during ambulation (walking).
How Is an Achilles Tendon Tear and Rupture Diagnosed?
Achilles tendon tears and ruptures are diagnosed with physical exam and imaging. Your doctor will obtain a history and physical exam, and feel the back of your calf, ankle, and heel to determine where the suspected tear/rupture is.
A defect can be felt where the Achilles tendon may have ruptured. In the case of a tear, a defect may not be easily felt.
Your doctor will test the function of the Achilles tendon by doing a Thompson test. You will need to lay on your stomach with the knee flexed 90 degrees.
Your doctor will press on your calf and see if your foot and ankle plantar flexes. In the case of an acute rupture, flexion will be absent and the Thompson test will be positive.
Check out this video by Physiotutors on how a Thompson test is performed.
Your doctor will order an x-ray to rule out any fractures. If the rupture occurs in the back of the heel, the tendon often pulls away a piece of bone from the heel during the injury.
Here’s an example by Clinics in Orthopedic Surgery of what that may look like.
Ultrasound is beneficial in identifying injury to the Achilles tendon. It will show discontinuity at the Achilles tendon site with fluid where the injury has occurred.
Ultrasound will also identify if the Achilles tendon is thick and diseased. However, in the case of Achilles tendon ruptures, ultrasound results can show false negatives. It can be difficult to visualize an Achilles tendon rupture due to hematoma (clot) at the rupture site.
A Magnetic Resonance Imaging Scan (MRI) is best to visualize Achilles tendon tears and ruptures.
An MRI provides detailed imaging of the Achilles tendon/bones/ligaments so that your doctor can visualize the extent of Achilles tendon injury.
How Do You Treat a Partially Torn Achilles Tendon Injury?
If you suspect you have a partial tear of the Achilles tendon, you should start icing the area and rest. Anti-inflammatory medications such as NSAIDs can are beneficial in reducing pain.
In the case of partial tears, they can usually be treated conservatively. Your doctor will instruct you to walk in a cast boot for 4-6 weeks. The goal is to allow the tendon to heal itself.
Afterward, you will need physical therapy for another month to help improve the strength of the tendon and range of motion.
It will take 6-12 weeks before you can resume activities regularly.
How Do You Treat a Rupture?
If you have an Achilles tendon rupture, your doctor will likely suggest surgery, unless you are at high risk for surgery due to your age and medical problems.
When you rupture the Achilles tendon, there is a gap that forms between the tendon at the rupture site. The further away the gap is, the more difficult it is for the body to heal it.
Excess scarring and irregular healing can occur. This will cause weakening of the tendon.
Repairing the Achilles tendon surgically allows the surgeon to reduce the gap between the ruptured ends of the tendon. The body thus does not have to create as much scar tissue to repair the tendon.
Also, surgical repair increases the strength of the tendon and decreases the recovery timeline. This is an important factor to consider, especially for athletes.
If the gap between the Achilles tendon rupture is large, your doctor will choose to perform a tendon transfer to fill the gap and improve strength. This involves using another tendon in your leg and transferring it.
If your Achilles tendon has ruptured away from the heel bone, your surgeon will reattach the tendon back into the heel using strong anchors.
You will need to stay off of your foot in a cast boot or cast for at least 4-6 weeks after surgery.
After this, your doctor will allow you to bear weight in the cast boot for an additional 2-4 weeks before transitioning you into athletic shoes.
Physical therapy is important to help regain strength and range of motion after surgery.
Your doctor will instruct you to complete physical therapy for 4-6 weeks after surgery.
Full recovery will take 12 weeks.
Can a Heel Cord Rupture Heal Without Surgery?
Achilles tendon ruptures can heal without surgery, however, healing will often take much longer, depending on the extent of the rupture.
In ruptures that have significant retraction of the tendon, excess scar tissue will form, making the tendon weaker and at risk for re-rupture.
However, ruptures with small gaps in the tendon can be treated effectively with immobilization in a cast boot for 6-8 weeks.
Full recovery will take anywhere from 3-6 months.
How Long Should You Wait for Achilles Tendon Surgery?
Achilles tendon surgery outcomes are the best if the surgery is done within the first week of the injury. This is because healing is still in the inflammatory phase. Repairing the surgery during this time can ensure better outcomes.
How Common Is a Ruptured Achilles Tendon?
The overall incidence of Achilles tendon ruptures is 2.1 per 100,000 person-years according to N. Lemme in the Orthopaedic Journal of Sports Medicine. Ruptures are more commonly seen in middle-aged individuals but can occur in anyone. Ruptures are more common in males than females.
When Should You See a Health Care Provider at Their Clinic?
- If you experience sudden, severe pain in the Achilles tendon
- If you have pain with swelling and bruising of the ankle
- If you have difficulty walking due to pain
- If you have pain that has been present for 2-3 weeks and isn’t getting better
- If you experience weakness when walking.
In conclusion, understanding the differences between a torn and ruptured Achilles tendon, which are common ankle conditions, is important for their accurate diagnosis and effective treatment. The Achilles tendon, being the largest tendon in the body, plays a crucial role in human mobility, and injuries to this body part can significantly impact daily activities.
A foot and ankle surgeon possesses the expertise to diagnose these conditions and offer a range of treatments to restore functionality. This article has covered popular topics associated with Achilles tendon injuries, providing valuable information on their causes, symptoms, diagnostic methods, and treatment options. Many healthcare offices are dedicated to improving the health and wellbeing of their patients through personalized care.
Patients suspecting an Achilles tendon injury are encouraged to review this information carefully and to not hesitate to schedule an appointment with their foot doctor for an evaluation. It is worth noting that prompt intervention can make a significant difference in the recovery process.
Patients should also consider learning about preventative measures such as exercises for strengthening the Achilles tendon to avoid such injuries, especially if there’s a history of Achilles tendonitis.
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