> Achilles Tendon Rupture
What is the Achilles Tendon?
You can feel your Achilles
tendon beneath the skin on the back of your ankle. It
is a fibrous band that connects your calf muscles to
your heel bone (calcaneus), which allows you to lift
your heel off the ground.
When you rupture your Achilles tendon, the tendon tears
completely across. When you flex your calf muscles,
they no longer pull up on your heel bone. A ruptured
Achilles tendon causes you to lose stability in your
The most common cause of an Achilles tendon rupture
is a sudden upward movement of your ankle, called a
dorsiflexion, while your calf muscle is contracted.
When the calf muscle and Achilles tendon contract, they
try to force your foot downward. A rupture can happen
if the outside forces pushing up on your foot are too
great for your Achilles tendon to withstand. Pushing
off on your foot, such as starting a sprint, when your
foot is bent downward (a position called plantar flexion)
also is a common way to rupture your Achilles tendon.
Achilles tendon ruptures occur most frequently in sports
such as basketball, tennis, soccer, and other activities
that impose forceful ankle movements. The injury is
more common in weekend warrior-type athletes between
their early 30s and late 40s. If you have not been engaging
in activities regularly, your Achilles tendon may be
tight and slightly inflexible. You could put yourself
at risk for many sports injuries, including an Achilles
rupture, if you suddenly increase the intensity of your
workouts or sports activities.
Most studies have shown that Achilles tendon ruptures
treated in a cast have a higher re-rupture rate compared
to those treated operatively. The injury also may cause
you to lose plantar flexion strength, which is the strength
you need to bend your foot downward. If you are middle
aged or elderly and relatively inactive, an Achilles
rupture can be treated in a cast knowing that you might
have some lack of push-off power, or plantar flexion.
Operating on your Achilles has a risk of infection or
wound problems in the back of the heel or calf that
is not an issue with cast treatment. Physicians consider
your age and activity level when deciding whether you
are a candidate for surgery. A younger patient involved
in competitive sports or who is very active may be a
candidate for early surgical intervention. The links
to the left describe treatments for Achilles tendon
ruptures in detail.
There usually are three
parts to an orthopedic evaluation: medical history,
a physical examination, and tests that your doctor may
Your physician likely will ask about your activities,
since they may have caused the Achilles rupture. You
may be asked when the soreness or pain began, and if
you have had any prior Achilles tendon injuries, your
physician will ask about the treatments you have tried
in the past. You may be asked how long your Achilles
tendon took to begin swelling, and whether you were
able to walk after you noticed the pain. Physicians
also typically ask about other conditions, such as diabetes
and allergies, and medications currently being taken.
You also may be asked about your physical and athletic
goals – information that will help decide what
treatment might be best for you in achieving those goals.
Physical Exam [top]
Physicians usually pinch your Achilles tendon with their
fingers to test for swelling and pain. If the tendon
itself is inflamed, your physician may be able to feel
warmth and swelling around the tissue, or, in chronic
cases, lumps of scar tissue. You will probably be asked
to walk around the exam room so your physician can examine
your stride. To check for complete rupture of the tendon,
your physician may perform the Thompson test. Your physician
squeezes your calf; if your Achilles is not torn, the
foot will point downward. If your Achilles is torn,
the foot will remain in the same position.
Should your physician require a closer look, these imaging
tests may be performed:
taken from different angles may be used to rule out
other problems, such as ankle fractures. MRI (magnetic
resonance imaging) uses magnetic waves to create pictures
of your ankle that let physicians look more clearly
at the tendons surrounding your ankle joint.