Achilles tendon is a strong fibrous cord present behind the ankle that connects the calf muscles to heel bone. It is used when you walk, run and jump. When the Achilles tendon becomes thin, weak, or
if it is not used, it may be susceptible to injury or damage. Achilles tendon rupture occurs most often in middle-aged athlete participating in sports that involve running, pivoting, and jumping.
Recreational sports that may cause Achilles rupture include tennis, racquetball, basketball, and badminton.
The Achilles tendon is most commonly injured by sudden plantarflexion or dorsiflexion of the ankle, or by forced dorsiflexion of the ankle outside its normal range of motion. Other mechanisms by
which the Achilles can be torn involve sudden direct trauma to the tendon, or sudden activation of the Achilles after atrophy from prolonged periods of inactivity. Some other common tears can occur
from overuse while participating in intense sports. Twisting or jerking motions can also contribute to injury. Fluoroquinolone antibiotics, famously ciprofloxacin, are known to increase the risk of
tendon rupture, particularly achilles.
The most common initial symptom of Achilles tendon rupture is a sudden snap at the back of the heels with intense pain. Immediately after the rupture, the majority of individuals will have difficult
walking. Some individuals may have had previous complains of calf or heel pain, suggesting prior tendon inflammation or irritation. Immediately after an Achilles tendon rupture, most individuals will
develop a limp. In addition, when the ankle is moved, the patient will complain of pain. In all cases, the affected ankle will have no strength. Once the Achilles tendon is ruptured, the individual
will not be able to run, climb up the stairs, or stand on his toes. The ruptured Achilles tendon prevents the power from the calf muscles to move the heel. Whenever the diagnosis is missed, the
recovery is often prolonged. Bruising and swelling around the calf and ankle occur. Achilles tendon rupture is frequent in elderly individuals who have a sedentary lifestyle and suddenly become
active. In these individuals, the tendon is not strong and the muscles are deconditioned, making recovery more difficult. Achilles tendon rupture has been reported after injection of corticosteroids
around the heel bone or attachment of the tendon. The fluoroquinolone class of antibiotics (such as ciprofloxacin [Cipro]) is also known to cause Achilles tendon weakness and rupture, especially in
young children. Some individuals have had a prior tendon rupture that was managed conservatively. In such cases, recurrence of rupture is very high.
In diagnosing an Achilles tendon rupture, the foot and ankle surgeon will ask questions about how and when the injury occurred and whether the patient has previously injured the tendon or experienced
similar symptoms. The surgeon will examine the foot and ankle, feeling for a defect in the tendon that suggests a tear. Range of motion and muscle strength will be evaluated and compared to the
uninjured foot and ankle. If the Achilles tendon is ruptured, the patient will have less strength in pushing down (as on a gas pedal) and will have difficulty rising on the toes. The diagnosis of an
Achilles tendon rupture is typically straightforward and can be made through this type of examination. In some cases, however, the surgeon may order an MRI or other advanced imaging tests.
Non Surgical Treatment
Your doctor will advise you exactly when to start your home physical therapy program, what exercises to do, how much, and for how long to continue them. Alphabet Range of Motion exercises. Typically,
the first exercise to be started (once out of a non-removable cast). While holding your knee and leg still (or cross your leg), you simply write the letters of the alphabet in an imaginary fashion
while moving your foot and ankle (pretend that the tip of your toe is the tip of a pencil). Motion the capital letter A, then B, then C, all the way through Z. Do this exercise three times per day
(or as your doctor advises). Freeze a paper cup with water, and then use the ice to massage the tendon area as deeply as tolerated. The massage helps to reduce the residual inflammation and helps to
reduce the scarring and bulkiness of the tendon at the injury site. Do the ice massage for 15-20 minutes, three times per day (or as your doctor advises). Calf Strength exercises. This exercise is
typically delayed and not used in the initial stages of rehabilitation, begin only when your doctor advises. This exercise is typically done while standing on just the foot of the injured side.
Sometimes, the doctor will advise you to start with standing on both feet. Stand on a step with your forefoot on the step and your heel off the step. The heel and forefoot should be level (neither on
your tip toes nor with your heel down). Lower your heel very slowly as low as it will go, then rise back up to the level starting position, again very slowly. This is not a fast exercise. Repeat the
exercise as tolerated. The number of repetitions may be very limited at first. Progress the number of repetitions as tolerated. Do this exercise one to two times per day (or as your doctor
Your doctor may recommend surgery if you?re young and active, or an athlete. However, this will depend on where your tendon is ruptured. If the rupture is at, or above, the point at which your tendon
merges with your calf muscle, for example, surgery may not be possible. There are three main types of surgery to repair a ruptured Achilles tendon. Open surgery. Your surgeon will make one long cut
in your leg to reach the tendon and repair it. Limited open surgery. Your surgeon will still make a single cut but it will be shorter. Percutaneous surgery. Your surgeon will make a number of small
cuts to reach the tendon and repair it. In all types of surgery, your surgeon will stitch the tendon together so it can heal. Each type of surgery has different risks. Open surgery is less likely to
injure one of the nerves in your leg for example, but has a higher risk of infection. Ask your surgeon to explain the risks in more detail. After your operation, you will need to wear a series of
casts or an adjustable brace on your leg to help your Achilles tendon heal. This will usually be for between four and eight weeks. There is a chance that your tendon will rupture again after the
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.