Ruptured Achilles Tendon

The Achilles tendon is the largest and most vulnerable tendon in the body. It joins the gastrocnemius (calf) and the soleus muscles of the lower leg to the heel bone of the foot. The gastrocnemius muscle crosses the knee and the ankle joints. Stress and tension in the Achilles tendon can lead to injury. Tendons are strong, but not very flexible, so they can only stretch so far before they get inflamed or tear.

The exact cause of Achilles tendon rupture is hard to say. It can happen suddenly, without warning, or following an Achilles tendonitis. It seems that weak calf muscles may contribute to problems.

An Achilles tendon rupture is more likely when the force on the tendon is greater than the strength of the tendon. This can occur when the foot is dorsiflexed while the lower leg moves forward and the calf muscles contract. Most ruptures happen during a forceful stretch of the tendon while the calf muscles contract.

This injury happens most often to "weekend warriors," according to the American College of Foot and Ankle Surgeons, middle-aged people who get their athletic activity in only on their days off.

Steroids and some antibiotics are also linked to Achilles tendon rupture. Many doctors avoid cortisone shots in or near the Achilles tendon due to this association.

A classic sign of an Achilles tendon rupture is the feeling of being hit in the calf area. Patients often report feeling a "pop". There may be sudden pain in the area, but the person cannot lift up onto his toes while weight bearing, and walking uphill or upstairs is difficult. Swelling may appear on the back of the leg in the Achilles area.

You should seek immediate medical attention after the injury. The doctor will perform a physical examination and discuss what happened. That is usually enough to make the diagnosis, although sometimes an MRI may be ordered.

A completely ruptured Achilles tendon can generally heal with or without surgery, often with a cast or walking boot. Earlier studies reported that surgical treatment led to a lower rate of re-rupture compared with non-surgical treatment, but newer studies have shown no difference in outcomes with or without surgery if treated with early rehabilitation. Regardless of treatment type, physical therapy to regain flexibility and then strength is an important part of regaining function after the injury heals.