Achilles Tendon Rupture
The Achilles tendon, or heel cord, is the large tendon at the back of the ankle. It is the thickest tendon in the body and connects the powerful calf muscles (gastrocsoleus complex) to the heel bone- acting as a pulley and transferring their power. The Achilles tendon enables you to point the foot downwards, to stand on tip toe and provides the power needed in push-off during walking, running and jumping. Achilles ruptures are fairly common and occur in about 1 in 5000 people. They are more common in males and between the ages of 30 -50 but can occur in anyone.
What is a rupture of the Achilles tendon?
This is a tear of the tendon. Achilles ruptures are increasingly common and may be ‘partial’, where only part of the tendon tears, or more commonly 'complete'.
What are the symptoms?
When the Achilles tendon ruptures there is usually sudden pain felt at the back of the ankle. Often a ‘snap’ or ‘pop’ is felt and heard. Initially it is very painful and most people find it difficult to walk. This settles which may disguise the severity of the injury. Swelling and bruising often develop afterwards and some people are able to feel a gap between the tendon ends. On occasion an Achilles rupture can be mistaken for an ankle sprain because of the similarities. An important difference between these injuries is that an ankle sprain will tend to heal very well without any intervention whereas an Achilles tendon rupture if left untreated can cause severe weakness in push-off, pain and a limp. Immediate specialist attention is therefore needed if an Achilles rupture is suspected.
What are the causes?
Achilles ruptures classically occur with sudden and powerful contractions of the calf muscle and are most commonly associated with ‘explosive’ sports such as squash and basketball. However, they can happen during any sport, after a fall or even from just stumbling after missing a step. Occasionally they may occur spontaneously. When the tendon is already abnormal or weak from conditions such as Achilles tendinopathy / Achilles tendonitis then less force is generally required and spontaneous ruptures are more common. Increased age, long term use of steroid medications, certain types of antibiotics (fluoroquinolones) and steroid injections near the tendon also weaken the tendon and may make it more likely to rupture.
How is it diagnosed?
If there are any concerns that there is a torn Achilles then urgent specialist attention should be sought. If correct treatment is delayed it can lead to problems. Unfortunately Achilles ruptures are often misdiagnosed as being an ankle sprain. The diagnosis though is generally fairly straightforward and an experienced Consultant Orthopaedic Foot & Ankle Surgeon will make the diagnosis on the basis of symptoms, the history of the injury and a detailed medical examination. More commonly Achilles ruptures are more commonly seen in A&E or by the GP. The ankle will need to be immobilised with the foot pointing down (plantarflexion) and crutches will be provided. Urgent follow-up should be organised with a specialist. In certain instances further investigation with an ultrasound scan or MRI scan may be needed.
Can it become worse?
If an Achilles tendon rupture is suspected then urgent medical care should be sought. Delayed treatment can limit the management options and may compromise the outcomes of treatment. In some cases delays can lead to tendon repair not being possible and it may be necessary to perform larger operations such as tendon turn down, V-Y lengthening or even a tendon transfer.
How can it be treated?
Non-operative treatment: As long as the ends of the torn Achilles tendon can be brought together then they will tend to heal together naturally. Pointing the foot down (plantarflexion) brings the tendon ends together in most acute cases and maintaining this position in a cast followed by a functional brace is then needed. The traditional method of managing these in a cast with absolutely no movement or weight-bearing through the injured leg is no longer used and the results with that type of treatment were often poor.
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