About Achilles Ruptures
Most people rupture their Achilles tendons while participating in an athletic activity although some ruptures occur after sudden unexpected movements such as a trip/fall or missing a stair. Most of the time, patients will feel a significant pop in the back of their leg and it may even be audible to those around them. It is not uncommon for someone to feel like they were kicked by someone or struck with an object in the back of their leg just above the heel. There is instant pain but the amount of pain that a patient feels is quite variable depending on the pattern of rupture.
Cause and Anatomy of Achilles Ruptures
The Achilles tendon is the tendinous connection from the gastroc and soleus muscle to the calcaneus. It provides a powerful plantar flexion force on the foot so that we can run and jump. Achilles tendon ruptures occur when the muscle contraction force exceeds the strength of the tendon. That leads to the pop so commonly heard and felt with an Achilles tendon injury.
Diagnosis of Achilles Ruptures
Diagnosis of Achilles tendon injuries is largely clinical. There is diminished tension in the posterior aspect of the leg and ankle and many times a palpable defect can be appreciated in the Achilles tendon itself. The diagnosis of a disrupted Achilles tendon can also be confirmed by the Thompson test which is performed by squeezing the calf muscle and watching the foot plantar flexed. If it does not, the connection between the calf and the heel/foot is disrupted. A diagnostic ultrasound or MRI can be performed if there is any question about the Achilles tendon rupture or to confirm the type of rupture.
What Are My Options?
Non-surgical treatment can be used to treat Achilles tendon ruptures if the rupture does not have much distraction between the tendon ends and the patient is willing to follow a significant rehabilitation program. For elderly patients and those with significant other health issues, non-operative treatment is usually implored.
In the United States, surgery for Achilles tendon ruptures in active patients is usually recommended. It provides the most accurate way to restore tension in the Achilles tendon and therefore restore function. Only when the tension is reestablished can the strong calf muscle perform its duty of plantar flexing the foot. The types of surgery used can vary but most Achilles tendon ruptures can be treated using minimally invasive techniques that limit wound complications, improve the contour of the tendon and allow for early rehabilitation. It is best to treat Achilles tendon ruptures within the first few weeks so it is important to present to your surgeon early to have the most options available.
Frequently Asked Questions
If I can still walk, does that mean my Achilles tendon is intact?
Not necessarily. Most people can still walk with an Achilles tendon rupture although they would find that walking quickly and/or running would not be possible.
If I can still move my foot and/or ankle, does that mean my Achilles tendon is intact?
Although the calf muscle is the most important plantar flex sore of the ankle, there are other tendons that also provide some plantarflexion. Just because you can move your ankle does not mean the Achilles tendon is not ruptured.