Tendons are the soft tissues connecting muscle to bone. 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 the foot and toe movements necessary for walking, running and jumping.
The Achilles tendon is often injured during sports activities, 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 men who involve in sports activities. The tendon ruptures due to weakness as a result of advanced age or from sudden bursts of activity during sports such as tennis, badminton and basketball. Having a history of tendonitis, certain diseases such as arthritis and diabetes, or certain antibiotics can make you more susceptible for ruptures.
The classic symptom of an Achilles tendon rupture is the inability to rise up on your toes. You may often experience 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 you lying on your 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 you can perform your normal activities.
Immediately following a torn or ruptured Achilles tendon you should employ the R.I.C.E. method as follows:
- Rest the injured part.
- Ice packs should be applied 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. 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.
As with all surgical procedures, Achilles tendon repair may be associated with certain complications such as infection, bleeding, nerve injury and blood clots.