Achilles tendon rupture

Achilles (uh-KILL-eez) tendon rupture is an injury that affects the tendon in the back of the lower leg. It mainly happens while playing sports, especially jumping sports, for fun. But it can happen to anyone.

The Achilles tendon is a strong fibrous cord that joins the muscles in the back of the calf to the heel bone. Stretching the Achilles tendon too far can make it tear partway or all the way. The tear is called a rupture.

The Achilles tendon helps with pointing the foot downward, rising on the toes and pushing off on the foot while walking. People use their Achilles tendons every time they walk and move their feet.

If the Achilles tendon ruptures, there may be a pop, then a sharp pain in the back of the ankle and lower leg. This is likely to make walking hard. Many people have surgery to repair the tear. But for many people, treatment without surgery works just as well.

Some people have no symptoms with an Achilles tendon rupture. But most people:

• Have a feeling of having been kicked in the calf.
• Have sharp pain and swelling near the heel.
• Find it hard to bend the foot downward or "push off" the injured foot when walking.
• Find it hard to stand on the toes on the injured foot.
• Hear a popping or snapping sound at the time of the injury.

When to see your doctor

Talk with a healthcare professional right away if you hear a pop in your heel, especially if it's hard to walk after that.

The cause of Achilles tendon rupture is often an injury that puts sudden force on the Achilles tendon. It can happen from:

• Jumping or sharp cutting and pivoting in a sport.
• Falling from a height or landing from a jump.
• Stepping into a hole.

Factors that may raise the risk of Achilles tendon rupture include:

• Age. The peak age for Achilles tendon rupture is 30 to 40.
• Sex assigned at birth. People assigned male at birth are up to five times more likely to have Achilles tendon rupture than are people assigned female at birth.
• Sports played for fun. Achilles tendon injuries happen more often during sports that involve running, jumping, and sudden starts and stops. These include soccer, basketball, volleyball and tennis.
• Steroid shots. Healthcare professionals sometimes inject steroids into an ankle joint to reduce pain and swelling. But steroid medicines can weaken nearby tendons. They've been linked to Achilles tendon ruptures.
• Certain antibiotics. Fluoroquinolone antibiotics, such as ciprofloxacin (Cipro) or levofloxacin, raise the risk of Achilles tendon rupture.
• Obesity. Excess weight puts more strain on the tendon.

To reduce your chance of having Achilles tendon issues follow these tips:

• Stretch and strengthen calf muscles. Stretch your calf muscles until you feel a pull, but not pain. Don't bounce during a stretch. Calf-strengthening exercises also can help the muscle and tendon take on more force and protect against injury.
• Vary your exercises. Mix high-impact sports, such as running, with low-impact sports, such as walking, biking or swimming. Limit activities that put a lot of stress on your Achilles tendons, such as activities that involve hill running and jumping.
• Choose safer running surfaces. Don't run on hard or slippery surfaces. Wear athletic shoes that fit well and have good cushioning.
• Add to your training slowly. Achilles tendon injuries often happen after training harder or all of a sudden. Add to how long, how far, how hard and how often you train by no more than 10% a week.

To diagnose Achilles tendon rupture, a healthcare professional checks the lower leg for tenderness and swelling. There may be a gap in the tendon if it has torn all the way.

The healthcare professional might ask you to kneel on a chair or lie face down with your feet hanging over the end of the exam table. The healthcare professional might then squeeze your calf muscle to see if your foot flexes. If it doesn't, you likely have ruptured your Achilles tendon.

An ultrasound or MRI can show whether the tendon is torn partly or all the way. These painless procedures take pictures of the tissues inside the body.

Treatment for a ruptured Achilles tendon often depends on your age, how active you are and how bad the injury is. Younger and more active people, especially athletes, tend to choose surgery to repair an Achilles tendon that's torn all the way. Older people and those not active in sports are more likely to opt for nonsurgical treatment.

Recent studies suggest that both types of treatment work equally well.

Treatment without surgery

This approach most often involves:

• Keeping the ankle still for a few weeks. This often involves wearing a walking boot with a heel wedge to bring the torn edges closer together or a cast with the foot flexed down for a few weeks.
• Resting the tendon and keeping weight off it by using crutches.
• Putting ice on the area.
• Taking pain relievers you can get without a prescription.

Treatment without surgery doesn't have the risks linked with surgery, such as infection. But it might increase the chances of another rupture. And recovery can take longer. But recent studies suggest that rehabilitation that involves moving and bearing weight early may help healing.

Surgery

The procedure most often involves a surgeon making a cut, called an incision, in the back of the lower leg. The surgeon then stitches the torn tendon together. Depending on the condition of the torn tissue, the surgeon might use donated tissue to make the repair.

Complications can include infection and nerve damage. Minimally invasive procedures have lower infection rates over those of open procedures.

Rehabilitation

After either treatment, physical therapy exercises can strengthen the leg muscles and the Achilles tendon. Most people return to their former level of activity within 18 to 24 months after the injury.

A type of rehabilitation known as functional rehabilitation starts earlier and moves faster than other types of physical therapy. Functional rehabilitation focuses on the whole body rather than just the injury. The purpose is to get people back to where they were before the tear, as an athlete, as a worker or in everyday life.

Some studies suggest that minimally invasive surgical repair with functional rehabilitation may offer the best results. This includes lower risk of infection and of the tendon tearing again. Study in this area is ongoing.

People with an Achilles tendon rupture often seek treatment right away at a hospital's emergency department. You also might want to talk with doctors who specialize in sports medicine or orthopedic surgery.

What you can do

Write a list that includes:

• Detailed descriptions of the symptoms and how and when the injury happened.
• Information about past medical conditions.
• All the medications, vitamins and dietary supplements you take, including doses.
• Questions to ask your healthcare professional.

What to expect from your doctor

Your healthcare professional may ask you some questions, including:

• How did this injury happen?
• Did you feel or hear a popping or snapping sound when the injury happened?
• Can you stand on tiptoe on that foot?