Tendon Rupture

Achilles  tendon rupture is an injury that affects the back of your lower leg.

The Achilles tendon is a strong fibrous cord that connects the muscles in the back of your calf to your heel bone. If you overstretch your Achilles tendon, it can tear (rupture) completely or just partially.

If your Achilles tendon ruptures, you might hear a pop, followed by an immediate sharp pain in the back of your ankle and lower leg that is likely to affect your ability to walk properly.

Surgery is often performed to repair the rupture. For some people, however, nonsurgical treatment works just as well.

Symptoms

• Pain, possibly severe, and swelling near the heel
• The feeling of having been kicked in the calf
• An inability to bend the foot downward
• An inability to stand on the toes on the injured leg
• A popping or snapping sound when the injury occurs

Causes

Rupture usually occurs in the section of the tendon situated within 2 1/2 inches (about 6 centimeters) of the point where it attaches to the heel bone. This section might be prone to rupture because blood flow is poor, which also can impair its ability to heal.

Ruptures often are caused by a sudden increase in the stress on your Achilles tendon. Common examples include:

• Increasing the intensity of sports participation, especially in sports that involve jumping
• Falling from a height
• Stepping into a hole

Risk factors

Factors that may increase your risk of Achilles tendon rupture include:

• Age. The peak age for Achilles tendon rupture is 30 to 40.
• Sex. Achilles tendon rupture is up to five times more likely to occur in men than in women.
• Recreational sports. Achilles tendon injuries occur more often during sports that involve running, jumping, and sudden starts and stops — such as soccer, basketball and tennis.
• Steroid injections. Doctors sometimes inject steroids into an ankle joint to reduce pain and inflammation. However, this medication can weaken nearby tendons and has been associated with Achilles tendon ruptures.
• Obesity. Excess weight puts more strain on the tendon.

Prevention

• Stretch and strengthen calf muscles. Stretch your calf until you feel a noticeable pull but not pain. Don't bounce during a stretch. Calf-strengthening exercises can also help the muscle and tendon absorb more force and prevent injury.
• Choose running surfaces carefully. Avoid or limit running on hard or slippery surfaces. Dress properly for cold-weather training, and wear well-fitting athletic shoes with proper cushioning in the heels.
• Increase training intensity slowly. Achilles tendon injuries commonly occur after an abrupt increase in training intensity. Increase the distance, duration and frequency of your training by no more than 10 percent weekly.

Diagnosis

During the physical exam, lower leg for tenderness and swelling.

one might be able to feel a gap in your tendon if it has ruptured completely.

If there's a question about the extent of your Achilles tendon injury — whether it's completely or only partially ruptured — MRI may be helpful

MANAGEMENT

Treatment for a ruptured Achilles tendon often depends on your age, activity level and the severity of your injury. In general, younger and more active people, particularly athletes, tend to choose surgery to repair a completely ruptured Achilles tendon, while older people are more likely to opt for nonsurgical treatment.

Nonsurgical treatment

This approach typically involves:

• Resting the tendon by using crutches
• Applying ice to the area
• Taking over-the-counter pain relievers
• Keeping the ankle from moving for the first few weeks, usually with a walking boot with heel wedges or a cast, with the foot flexed down

Nonoperative treatment avoids the risks associated with surgery, such as infection.

However, a nonsurgical approach might increase your chances of re-rupture and recovery can take longer.

Surgery

The procedure generally involves making an incision in the back of your lower leg and stitching the torn tendon together. Depending on the condition of the torn tissue, the repair might be reinforced with other tendons.

Complications can include infection and nerve damage. Minimally invasive procedures reduce infection rates over those of open procedures.

Rehabilitation

After either treatment, you'll have physical therapy exercises to strengthen your leg muscles and Achilles tendon. Most people return to their former level of activity within four to six months. It's important to continue strength and stability training after that because some problems can persist for up to a year.