When the Achilles Tendon Ruptures
Although relatively uncommon, a ruptured or torn Achilles tendon is a very serious and potentially permanently debilitating injury that may require a surgical repair and casting or splinting to properly heal. If you suspect this has happened to you, read carefully and consult a trusted sports physician as soon as possible.
What actually causes the Achilles tendon to rupture is not entirely known, though it is associated with overworking unused or overused muscles. It is an injury common to the weekend warrior who doesn't exercise consistently but may overexercise on the weekend. It can happen to seasoned athletes too. The mechanism of injury is a force that increases the tension in the Achilles tendon beyond its tensile strength. A forceful stretch of the tendon or a contraction of the muscles can create this force. Most often it is a combination of the two forces.
Occasionally, ruptures occur at the tendon-bone interface or within a 3- to 5-centimeter area above the tendon's insertion point on the heel. Since vascularity decreases with age, this frequently occurs in older athletes. A weakening of the Achilles tendon has been observed following intratendinous steroid injection.
Therefore, injections of steroids are not recommended at this location. Diseases associated with an increased incidence of tendon rupture include gout, systemic lupus erythematosus, rheumatoid arthritis, and tuberculosis.
Diagnosing a Ruptured Achilles
The cardinal signs of a ruptured Achilles tendon are severe heel pain and the inability to walk. Physical examination of the site of a recent rupture may reveal a noticeable gap. Swelling is observed. The most frequently prescribed clinical test is called the Thompson test: As you lie on your stomach, your calf is squeezed. If your foot plantar-flexes then you do not have a completely torn Achilles tendon.
However, if the foot does not plantar-flex when the calf is squeezed, chances are the Achilles tendon is completely torn. An MRI will accurately reveal the extent of the tear. Diagnostic ultrasound is also used to assist in the diagnosis of a torn Achilles tendon.
Treating a Ruptured Achilles Tendon
Complete tears of the Achilles tendon are usually treated with surgical repair followed by up to twelve weeks in a series of casts. Partial tears are sometimes treated with casting alone for up to twelve weeks or are sometimes treated as complete tears, with surgery and casting. A heel lift is usually used for six months to one year following removal of the cast. Following cast removal, rehabilitation with a physical therapist is necessary to regain your flexibility and muscle strength and also to restore your normal walking and eventually your running gait.