Tendons are the soft tissues connecting muscles to the bones. The Achilles tendon is the longest tendon in the body and is present behind the ankle, joining the calf muscles with the heel bone. Contraction of the calf muscles tightens the Achilles tendon and pulls the heel, enabling foot and toe movements necessary for walking, running and jumping.
The Achilles tendon is often injured during sports resulting in an inflammatory condition called tendonitis which is characterized by swelling and pain. In some cases, severe injury results in a tear or rupture of the Achilles tendon requiring immediate medical attention.
The tear or rupture of the Achilles tendon is commonly seen in middle aged male who involve in sports activities occasionally or in weekend athletes. The tendon ruptures because of weakened tendons due to advanced age or from sudden bursts of activity during sports such as tennis, badminton, and basketball.
People with a history of tendonitis, those suffering from certain diseases such as arthritis and diabetes, or taking certain antibiotics are more susceptible for ruptures.
The classic symptom of an Achilles Tendon rupture is the inability to rise up on your toes. Patients often describe a “popping” or “snapping” sound with severe pain, swelling and stiffness in the ankle region followed by bruising of the area. If the tendon is partially torn and not ruptured, pain and swelling may be mild.
The diagnosis of a torn or ruptured Achilles tendon starts with a physical examination of the affected area, followed by a Thompson test in which the calf muscle is pressed with the patient lying on their stomach to check whether the tendon is still connected to the heel or not.
In certain cases, an ultrasound or MRI scan may be needed for a clear diagnosis.
The main objective of treatment is to restore the normal physiology of the Achilles tendon so the patient can perform activities as before the injury.
Immediately following a torn or ruptured Achilles tendon you should employ the RICE method as follows:
- Rest of the injured part
- Ice packs application at the site of injury to prevent swelling
- Compress the injured area to prevent swelling
- Elevate the injured part to reduce swelling
Treatment of a torn or ruptured Achilles tendon includes non-surgical or surgical methods. Non-surgical methods involve casting the injured area for six weeks for the ruptured tendon to reattach itself and heal. After removal of the cast, physical therapy is recommended to prevent stiffness and restore lost muscle tone.
Surgery may be recommended especially for competitive athletes, those who perform physical work, or in instances where the tendon re-ruptures. Your surgeon will stitch the torn tendon back together with strong sutures and tie the sutures together. Your surgeon may reinforce the Achilles tendon with other tendons depending on the extent of the tear. If the tendon has avulsed or pulled off the heel bone, your surgeon will reattach the tendon to the heel bone.
Risks and complications
Every medical treatment including surgeries is associated with certain risks and complications. Some of them include infection, bleeding, nerve injury, and blood clots.