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)
and allows you to lift your heel off the ground.av=PAT&doc_id=29"
target="_new">William G. Hamilton,
M.D., team physician for the New York Knicks and
New Jersey Nets.
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 ankle joint.av=PAT&doc_id=29" target="_new">William
G. Hamilton, M.D., team physician for the New York
Knicks and New Jersey Nets.
The most common cause of an Achilles tendon rupture
is a sudden upward movement of your ankle (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 (plantar flexion) also
is a common way to rupture your Achilles tendon.
Basketball and tennis are sports in which Achilles
tendon ruptures seem to occur frequently. The injury
is more common in weekend-warrior type athletes
over 40. 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.av=PAT&doc_id=29"
target="_new">William G. Hamilton,
M.D., team physician for the New York Knicks and
New Jersey Nets.
Considerations
Most studies have shown that Achilles tendon ruptures
treated in a cast have a higher re-rupture rate
compared to those treated operatively. You also
may lose plantar flexion strength, which is the
strength you need to bend your foot downward.
If you are middle aged or elderly and not that
active, 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
look at your age and activity level when deciding
whether you are a candidate for surgery. A younger
patient involved in competitive sports or who
is pretty active may be a candidate for early
surgical intervention.av=PAT&doc_id=29"
target="_new">William G. Hamilton,
M.D., team physician for the New York Knicks and
New Jersey Nets.
There usually are three
parts to an orthopedic evaluation: medical history,
a physical examination, and tests that your doctor
may order.
MEDICAL HISTORY
Your physician likely will ask about your activities,
which may have caused the Achilles rupture. You
may be asked when the soreness or pain began.
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
Physicians usually pinch
your Achilles tendon with their fingers to test
for swelling and pain. If the tendon itself is
damaged, your physician may be able to feel 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:
X-rays
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
more clearly look at the tendons surrounding your
ankle joint.
