An Achilles tendon rupture is when part or all of your tendon is torn. The Achilles tendon connects the calf muscle in your lower leg to your heel bone. It allows you to point your foot down and to rise on your toes. A tear is caused by an injury or increased pressure, such as during sports or a fall. The following may make your Achilles tendon weak or stiff, and more likely to tear. A past tendon tear. Lack of physical activity. Abnormal bone structure in your foot. Obesity. Older age. Medicines, such as steroids and antibiotics.
The tendon usually ruptures without any warning. It is most common in men between the ages of 40-50, who play sports intermittently, such as badminton and squash. There was probably some degeneration in the tendon before the rupture which may or may not have been causing symptoms.
Patients who suffer an acute rupture of the Achilles tendon often report hearing a "pop" or "snap." Patients usually have severe pain the back of the lower leg near the heel. This may or may not be accompanied by swelling. Additionally, because the function of the Achilles tendon is to enable plantarflexion (bending the foot downward), patients often have difficulty walking or standing up on their toes.
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.
Non Surgical Treatment
Treatment of a ruptured Achilles tendon is usually conservative (non-operative) in a Controlled Motion Ankle (CAM) Boot or it may require surgery. The current consensus based on research is to treat them conservatively since the functional outcome and chance of re-rupture is similar (7% to 15%) using both approaches but surgical intervention has a higher risk of infection. Achilles tendon surgery is usually considered if your Achilles has re-ruptured or there is delay of two weeks between the rupture and the diagnosis and commencement of conservative bracing and treatment.
There are a variety of ways to repair an Achilles tendon rupture. The most common method is an open repair. This starts with an incision made on the back of the lower leg starting just above the heel bone. After the surgeon finds the two ends of the ruptured tendon, these ends are sewn together with sutures. The incision is then closed. Another repair method makes a small incision on the back of the lower leg at the site of the rupture. A series of needles with sutures attached is passed through the skin and Achilles tendon and then brought out through the small incision. The sutures are then tied together. The best surgical technique for your Achilles rupture will be determined by your orthopaedic foot and ankle surgeon.