Is Achilles Tendon Rupture a Common Injury?
Yes, Achilles tendon rupture is one of the most common injuries of lower leg in athletes and non-athletes individuals.
Is Achilles Tendon Rupture More Common in Male or Female?
Achilles tendon rupture is more common in male then female. Male to female Achilles tendon injury ratio is about 5:1.
What is the Anatomy of Achilles Tendon (AT)?
Achilles tendon is a distal part of calf muscles called gastrocnemius and soleus muscles. It is a strong fibrous tendon attached to calcaneus bone at the bottom of foot. Tendon is firmly attached to calcaneus bone, around bursae. Bursa is a jelly like fluid sacs, which lies between tendon and calcaneus bone. It is one of the strongest muscle in human body.
What are the Functions of the Achilles Tendon (AT)?
Calf muscles and tendon is consistently used in ambulation, jogging and as well as bouncing activities of ankle joint.
What Causes Rupture of Strong Tendon like Achilles Tendon (AT)?
Average weight of 50 to 65 kg is transmitted through legs to the Achilles tendon. Tendon is made up of fibrous tissue and has limited blood supply despite being strong tendon. Ischemic changes (less blood supply) or over stretching of the calf muscles and Achilles Tendon (AT) ligament can cause injury and rupture of the Achilles Tendon (AT). Achilles tendon rupture is either partial or complete.
Which is the Most Common Anatomical Site for Achilles Tendon Rupture?
Achilles Tendon may rupture anywhere along the length of the tendon, which you can palpate from bottom of calf muscle mass to attachment at calcaneus bone. Most common location of Achilles tendon rupture is about 2.5 inch above the attachment of the tendon to calcaneus bone.
What are the Causes of Achilles Tendon Rupture?
Achilles Tendon rupture occurs following fall, tripping or direct injury with sharp or blunt object to tendon.
What are the Risk Factors Associated with Achilles Tendon Rupture?
- Achilles tendon rupture is more common in males.
- Ruptured Achilles tendon is seen more often in individual of age 30 to 40 years.
- Sporting activities like jogging, tennis, soccer, basketball and football may cause severe force and torque over tendon while twisting and movement of ankle causing tear or fracture of Achilles tendon.
- Frequent steroid injection for tendinitis can cause steroid induced weakening of Achilles tendon and may lead to fracture or rupture of Achilles tendon.
- Achilles tendon rupture is often seen when treated with antibiotics like fluoroquinolone, ciprofloxacin (Cipro) or levofloxacin (Levaquin).
What are the Symptoms of Achilles Tendon Rupture?
Immediate Symptoms Following Achilles Tendon Rupture Are:
- Sharp excruciating pain at the back of ankle and calf muscles is one of the immediate symptoms of ruptured or torn Achilles tendon.
- Inability to walk or put weight on foot or ankle or leg of injured side is also a common immediate symptom of Achilles tendon rupture.
- Popping sound felt or heard just before the injury.
Delayed Symptoms of Achilles Tendon Rupture Are:
- Severe intractable pain.
- Ankle swelling on the back of tendon.
- Hemorrhagic discoloration.
- Inability to bend or twist foot at ankle joint is also a common symptom of Achilles tendon rupture.
- Inability to walk or put pressure on injured leg.
What to do on Sustaining an Achilles Tendon Rupture?
If you have ruptured your Achilles tendon, you should avoid putting any weight on your foot or ankle. You should ambulate with assistive device until you see your doctor or visit ER. You should see primary care physician (PCP) either family physician or internal medicine doctor as soon as possible. Immediate immobilization of joint and foot may be necessary to prevent further damage in case of tear or rupture of Achilles tendon. If you cannot see your PCP, you should go to ER immediately.
What are the Different Diagnostic Tests Done To Evaluate Achilles Tendon Rupture?
Diagnostic clinical examination and lab studies are as follows:
- Simmond’s test also known as Thomson test. Normal test indicates when calf muscle is squeezed muscle contraction pulls Achilles tendons and causes plantar flexion (foot bends down). Test is performed in prone position (lying dawn on stomach). Test is positive if plantar flexion is not observed as seen in cases of patients with Achilles tendon rupture.
- O’Brien Test – 23 or 25 G sterile needle is passed through the skin into tendon, after skin is prepped with antiseptic Betadine. Test is considered positive if movement of needle is observed leaning towards the toes.
- X-ray is used to diagnose fracture or dislocation of ankle joint as a cause of pain.
- MRI studies can differentiate tendon rupture, tendinitis and bursitis as a cause of pain.
- Ultrasound- determines muscle thickness, tear and hematoma (blood clot).
What is the Treatment for Achilles Tendon Rupture?
Conservative Non-invasive Treatment for Contusion or Minor Achilles Tendon Rupture:
- Pain and anti-inflammatory medications- Motrin, Naproxen and Celebrex.
- Ankle braces or plaster cast for 4 to 6 weeks depends on extent of Achilles tendon rupture.
- Physical therapy for Achilles tendon rupture is considered after the wound is healed and pain subsides.
- Rehab treatment for Achilles tendon rupture may be necessary in few cases. Rehab is necessary for gaining strength of lower leg, correction of any abnormal gait and if necessary to teach how to use prosthetic shoes or walking aid like cane or walker.
Invasive Treatment for Minor Achilles Tendon Rupture:
- Acupuncture treatment.
- Local anesthesia injection without cortisone.
Surgery for Major Achilles Tendon Rupture
Indication for surgical repair of Ruptured Achilles Tendon:
- Surgery is indicated if there is major Achilles tendon rupture.
- Fracture and separation of tendo-achilles.
- Repeated Achilles tendon rupture or tear after conservative treatment may require surgery.
- Percutaneous Surgery.
- Open Surgery.
- Direct suturing of the ruptured Achilles tendon.
- After direct suturing of the ruptured Achilles tendon, tendon is reinforced by wrapping harvested muscles around the tendon. There are two different types of surgeries; open surgery and percutaneous surgery.
- Instead of wrapping muscles around tendon after suturing ruptured Achilles tendon, surgeon may use a mesh made up of collagen or artelon to reinforce the Achilles tendon.
- American Academy of Orthopaedic Surgeons (AAOS). (2021). Achilles Tendon Rupture. https://orthoinfo.aaos.org/en/diseases–conditions/achilles-tendon-rupture/
- Al Hares, F. A., & Al-Faham, A. S. (2016). Achilles Tendon Rupture. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK430755/
- National Institute for Health and Care Excellence (NICE). (2016). Achilles Tendon Rupture: Management. https://www.nice.org.uk/guidance/ng40/chapter/Recommendations#surgical-repair-of-ruptured-achilles-tendon
- Khan, R. J., Fick, D., & Keogh, A. (2014). Treatment options for Achilles Tendon rupture: A systematic review. Injury, 45(4), 587-592. https://doi.org/10.1016/j.injury.2013.09.020