Overview
The Achilles tendon is an important part of the leg. It is located just behind and above the heel. It joins the heel bone to the calf muscles. Its function is to help in bending the foot downwards at the ankle (this movement is called plantar flexion by doctors). If the Achilles tendon is torn, this is called an Achilles tendon rupture. The tear may be either partial or complete. In a partial tear, the tendon is partly torn but still joined to the calf muscle. With complete tears, the tendon is completely torn so that the connection between the calf muscles and the ankle bone is lost.
Causes
As with any muscle or tendon in the body, the Achilles tendon can be torn if there is a high force or stress on it. This can happen with activities which involve a forceful push off with the foot, for example, in football, running, basketball, diving, and tennis. The push off movement uses a strong contraction of the calf muscles which can stress the Achilles tendon too much. The Achilles tendon can also be damaged by injuries such as falls, if the foot is suddenly forced into an upward-pointing position, this movement stretches the tendon. Another possible injury is a deep cut at the back of the ankle, which might go into the tendon. Sometimes the Achilles tendon is weak, making it more prone to rupture. Factors that weaken the Achilles tendon are as follows. Corticosteroid medication (such as prednisolone) - mainly if it is used as long-term treatment rather than a short course. Corticosteroid injection near the Achilles tendon. Certain rare medical conditions, such as Cushing's syndrome, where the body makes too much of its own corticosteroid hormones. Increasing age. Tendonitis (inflammation) of the Achilles tendon. Other medical conditions which can make the tendon more prone to rupture; for example, rheumatoid arthritis, gout and systemic lupus erythematosus (SLE), lupus. Certain antibiotic medicines may slightly increase the risk of having an Achilles tendon rupture. These are the quinolone antibiotics such as ciprofloxacin and ofloxacin. The risk of having an Achilles tendon rupture with these antibiotics is actually very low, and mainly applies if you are also taking corticosteroid medication or are over the age of about 60.
Symptoms
When the Achilles tendon ruptures a loud bang or popping sound may be heard. The person may feel that they have been hit or kicked in the back of the lower leg and often they will look over their shoulder to see who or what has hit them. This is quickly followed by the sudden onset of sharp pain in the tendon and a loss of strength and function. If a complete rupture has occurred it may not be possible to lift the heel off the ground or point the toes. Often the degree of pain experienced, or lack of it, can be inversely proportional to the extent of the injury, ie a partial rupture may in fact be more painful than a complete rupture.
Diagnosis
Some patients mistakenly believe the tendon is working if they can push the foot down, however, patients will usually be able to move the foot up and down while sitting because the other surrounding muscles and tendons are still intact. Trying to push up while standing and applying body weight to the foot will reveal the true weakness. Sensation and circulation to the foot and ankle will be normal. In addition, x-rays will be normal unless the Achilles injury involves pulling off (avulsion) of the bone on the calcaneus (heel bone). This is quite rare, occurring in only a small fraction of patients with Achilles injuries. Patients suffering this type of Achilles avulsion injury tend to be older with weaker bone. Imaging Studies. Plain x-rays will be negative in patients who have suffered an Achilles tendon rupture. The rupture can be seen on ultrasound or MRI. However, these studies are not indicated for acute ruptures unless there is some uncertainty about the diagnosis. For chronic problems of the Achilles or ruptures that are old, an MRI may be very helpful.
Non Surgical Treatment
Non-surgical treatment of Achilles tendon rupture is usually reserved for patients who are relatively sedentary or may be at higher risk for complications with surgical intervention (due to other associated medical problems). This involves a period of immobilization, followed by range of motion and strengthening exercises; unfortunately, it is associated with a higher risk of re-rupture of the tendon, and possibly a less optimal functional outcome.
Surgical Treatment
Regaining Achilles tendon function after an injury is critical for walking. The goal of Achilles tendon repair is to reconnect the calf muscles with the heel bone to restore push-off strength. Those best suited for surgical repair of an acute or chronic Achilles tendon rupture include healthy, active people who want to return to activities such as jogging, running, biking, etc. Even those who are less active may be candidates for surgical repair. Non-operative treatment may also be an option. The decision to operate should be discussed with your orthopaedic foot and ankle surgeon.
Prevention
Good flexibility of the calf muscles plays an essential role in the prevention of Achilles tendon injuries. It is also important to include balance and stability work as part of the training programme. This should include work for the deep-seated abdominal muscles and for the muscles that control the hip. This might at first appear odd, given the fact that the Achilles are a good distance from these areas, but developing strength and control in this area (core stability) can boost control at the knee and ankle joints. Training errors should be avoided. The volume, intensity and frequency of training should be monitored carefully, and gradually progressed, particularly when introducing new modes of training to the programme. Abrupt changes in training load are the primary cause of Achilles tendinopathy.
The Achilles tendon is an important part of the leg. It is located just behind and above the heel. It joins the heel bone to the calf muscles. Its function is to help in bending the foot downwards at the ankle (this movement is called plantar flexion by doctors). If the Achilles tendon is torn, this is called an Achilles tendon rupture. The tear may be either partial or complete. In a partial tear, the tendon is partly torn but still joined to the calf muscle. With complete tears, the tendon is completely torn so that the connection between the calf muscles and the ankle bone is lost.
Causes
As with any muscle or tendon in the body, the Achilles tendon can be torn if there is a high force or stress on it. This can happen with activities which involve a forceful push off with the foot, for example, in football, running, basketball, diving, and tennis. The push off movement uses a strong contraction of the calf muscles which can stress the Achilles tendon too much. The Achilles tendon can also be damaged by injuries such as falls, if the foot is suddenly forced into an upward-pointing position, this movement stretches the tendon. Another possible injury is a deep cut at the back of the ankle, which might go into the tendon. Sometimes the Achilles tendon is weak, making it more prone to rupture. Factors that weaken the Achilles tendon are as follows. Corticosteroid medication (such as prednisolone) - mainly if it is used as long-term treatment rather than a short course. Corticosteroid injection near the Achilles tendon. Certain rare medical conditions, such as Cushing's syndrome, where the body makes too much of its own corticosteroid hormones. Increasing age. Tendonitis (inflammation) of the Achilles tendon. Other medical conditions which can make the tendon more prone to rupture; for example, rheumatoid arthritis, gout and systemic lupus erythematosus (SLE), lupus. Certain antibiotic medicines may slightly increase the risk of having an Achilles tendon rupture. These are the quinolone antibiotics such as ciprofloxacin and ofloxacin. The risk of having an Achilles tendon rupture with these antibiotics is actually very low, and mainly applies if you are also taking corticosteroid medication or are over the age of about 60.
Symptoms
When the Achilles tendon ruptures a loud bang or popping sound may be heard. The person may feel that they have been hit or kicked in the back of the lower leg and often they will look over their shoulder to see who or what has hit them. This is quickly followed by the sudden onset of sharp pain in the tendon and a loss of strength and function. If a complete rupture has occurred it may not be possible to lift the heel off the ground or point the toes. Often the degree of pain experienced, or lack of it, can be inversely proportional to the extent of the injury, ie a partial rupture may in fact be more painful than a complete rupture.
Diagnosis
Some patients mistakenly believe the tendon is working if they can push the foot down, however, patients will usually be able to move the foot up and down while sitting because the other surrounding muscles and tendons are still intact. Trying to push up while standing and applying body weight to the foot will reveal the true weakness. Sensation and circulation to the foot and ankle will be normal. In addition, x-rays will be normal unless the Achilles injury involves pulling off (avulsion) of the bone on the calcaneus (heel bone). This is quite rare, occurring in only a small fraction of patients with Achilles injuries. Patients suffering this type of Achilles avulsion injury tend to be older with weaker bone. Imaging Studies. Plain x-rays will be negative in patients who have suffered an Achilles tendon rupture. The rupture can be seen on ultrasound or MRI. However, these studies are not indicated for acute ruptures unless there is some uncertainty about the diagnosis. For chronic problems of the Achilles or ruptures that are old, an MRI may be very helpful.
Non Surgical Treatment
Non-surgical treatment of Achilles tendon rupture is usually reserved for patients who are relatively sedentary or may be at higher risk for complications with surgical intervention (due to other associated medical problems). This involves a period of immobilization, followed by range of motion and strengthening exercises; unfortunately, it is associated with a higher risk of re-rupture of the tendon, and possibly a less optimal functional outcome.
Surgical Treatment
Regaining Achilles tendon function after an injury is critical for walking. The goal of Achilles tendon repair is to reconnect the calf muscles with the heel bone to restore push-off strength. Those best suited for surgical repair of an acute or chronic Achilles tendon rupture include healthy, active people who want to return to activities such as jogging, running, biking, etc. Even those who are less active may be candidates for surgical repair. Non-operative treatment may also be an option. The decision to operate should be discussed with your orthopaedic foot and ankle surgeon.
Prevention
Good flexibility of the calf muscles plays an essential role in the prevention of Achilles tendon injuries. It is also important to include balance and stability work as part of the training programme. This should include work for the deep-seated abdominal muscles and for the muscles that control the hip. This might at first appear odd, given the fact that the Achilles are a good distance from these areas, but developing strength and control in this area (core stability) can boost control at the knee and ankle joints. Training errors should be avoided. The volume, intensity and frequency of training should be monitored carefully, and gradually progressed, particularly when introducing new modes of training to the programme. Abrupt changes in training load are the primary cause of Achilles tendinopathy.