| What Is an Achilles Tendon Rupture? |
First, there was a pop or snap. Then came an immediate sharp pain in the back of your ankle and lower leg, making it impossible to walk on your foot properly. It almost felt like you’d been kicked, or even shot.
This is what it typically feels like to rupture an Achilles tendon — a large, strong fibrous cord that connects the muscles in the back of your lower leg to your heel bone (calcaneus). Your Achilles tendon — also called your heel cord — helps you point your foot downward, rise on your toes and push off your foot as you walk. You rely on it virtually every time you move your foot.
If you overstretch your Achilles tendon, it can tear (rupture). A rupture can be partial or complete. Usually the rupture occurs just above your heel bone, but it can happen anywhere along the tendon.
Several other problems can affect your Achilles tendon, making it painful or in need of treatment. These include:
- Bursitis. You have more than 150 bursae throughout your body. These tiny sacs of fluid
cushion movement between bones and muscles and tendons attached to bones, facilitating movement by
limiting friction. When a bursa becomes inflamed, the resulting disorder is called bursitis.
Inflammation can occur in the bursa between your heel bone and your Achilles tendon. This type of
bursitis is called retrocalcaneal bursitis.
- Tendinitis. Achilles tendinitis is inflammation of your Achilles tendon. The pain is the result of tiny tears and inflammation in the tissue of the tendon itself. These tiny tears result from repeated stress on the tendon.
|
| Signs and Symptoms |
Pain and swelling near your heel and an inability to bend your foot downward or walk on it normally are signs that you may have ruptured your Achilles tendon. If you’ve ruptured the tendon completely, you won’t be able to rise on your toes on the injured leg. The pain can sometimes be very severe.
Often people also report hearing a popping or snapping sound when the injury occurs. With a partial rupture, you may still be able to move your foot, and you may experience only minor pain and swelling.
Bursitis involving the area where your Achilles tendon attaches to your heel bone usually begins with pain and irritation at the back of the heel. There may be visible redness and swelling in the area, and the back of your shoe may further irritate the condition.
Tendinitis of the Achilles tendon usually develops at a point just above where the tendon attaches to your heel bone. Signs that you may have Achilles tendinitis include pain when pushing off during walking or when rising on your toes, redness and swelling over your Achilles tendon, and a crackling or creaking sound when you touch or move the tendon.
| Causes |
Achilles tendon injuries result from repeated stress on the tendon, which may be caused or aggravated by the following:
- Overuse
- Running on hills and hard surfaces
- Poor stretching habits
- Tight calf muscles
- Weak calf muscles
- Worn-out shoes
- Flat feet
Sometimes, though, injuries can occur from simply overstretching your Achilles tendon while doing a simple activity, such as gardening. Occasionally, even highly conditioned athletes rupture an Achilles tendon.
| When to Seek Medical Advice |
See your doctor if you experience persistent pain near the back of your heel or in the area of your Achilles tendon and the pain doesn't greatly improve within 1 to 2 weeks, despite self-care measures. See your doctor immediately if you experience symptoms of an Achilles tendon rupture.
| Screening and Diagnosis |
To diagnose Achilles tendon problems, your doctor will likely ask questions about the physical activities you engage in and perform an examination of your feet, ankles and legs. If it's clear your Achilles tendon is ruptured, you may be scheduled for surgery. If there's a question about a partial rupture of your Achilles tendon, your doctor may order a magnetic resonance imaging (MRI) scan, a painless procedure that uses magnetic fields to create a computer image of soft tissues of your body.
| Complications |
If Achilles tendinitis is left untreated and the tendon continues to sustain multiple, small tears through exercise and repeated movement, the tendon can rupture. Untreated Achilles bursitis can lead to increased swelling, pain and disability.
| Treatment |
Achilles tendon ruptures can be treated surgically or nonsurgically.
A complete rupture of an Achilles tendon is usually treated with surgery. The procedure generally involves making an incision in the back of your leg and stitching the torn tendon together. Afterward, you need to spend about 6 to 12 weeks with your leg in a walking boot, cast, brace or splint.
To prevent the tendon from healing in a stretched position, making it useless, your foot may initially be pointed slightly downward in the boot or brace, and then gradually moved to a neutral position.
Nonsurgical treatment of Achilles tendon ruptures typically involves wearing a cast or walking boot, which allows the ends of your torn tendon to reattach themselves on their own. Studies indicate that this method can be effective and doesn't have the same risk of complications, such as infection, that can occur with surgery.
However, the incidence of re-rupture is higher with the nonsurgical approach and recovery can take longer. Surgical repair of a ruptured Achilles tendon is usually preferable, especially if you’re active and want to continue to take part in strenuous recreational activities. Surgery is generally very effective, and your risk of complications is typically quite low.
Bursitis and tendinitis are usually treated with a combination of self-care measures. Rarely is surgery needed. Cortisone injections for these conditions may be beneficial in select patients, but repeated injections aren't generally recommended because of the increased risk of rupture of the tendon.
| Prevention |
To help prevent an Achilles tendon injury, gently stretch your Achilles tendon and calf muscles before taking part in physical activities. Perform stretching exercises slowly. Never bounce during a stretch and stretch to the point you feel a noticeable pull, but not pain.
To stretch your Achilles tendons:
- Stand at arm's length from a wall with your palms flat against the wall.
- Keep one leg back with your knee straight and your heel flat on the floor.
- Slowly bend your elbows and front knee as you lean toward the wall.
- Hold this position for 30 to 60 seconds.
- Switch leg positions and repeat.
To further reduce your chance of developing Achilles tendon problems, avoid activities that place excessive stress on your heel cords, such as hill running and jumping activities. If you notice pain during exercise, rest. If one exercise or activity causes you particular, persistent pain, try another. Alternate high-impact sports, such as running, with low-impact sports, such as walking, biking or swimming.
Strengthening your calf muscles also can help prevent injury to your Achilles tendon. To strengthen your calf muscles, practice toe raises. Standing flat, raise yourself up on your toes. Hold the position for 30 to 60 seconds, then slowly go back down to a stand. Start with raising just your body weight. Later, you can add hand weights as you do this exercise or raise your body weight on just one foot. Some exercise machines specifically help you do toe raises. This type of strengthening can be especially helpful in recovering from chronic Achilles tendinitis.
To avoid a recurrence of an Achilles tendon injury, follow these guidelines:
- Use warm-up and cool-down exercises and calf-strengthening exercises.
- Apply ice to your Achilles tendon after exercise.
- Alternate high-impact sports with low-impact sports, so as not to overwork your Achilles tendons.
|
| Self-Care |
To treat Achilles tendinitis or bursitis at home, P.R.I.C.E. is the word to remember — protection, rest, ice, compression and elevation. This treatment can help speed your recovery and help prevent further injuries when Achilles tendon problems resurface. P.R.I.C.E. involves doing the following:
- Protection. Immobilize the tendon to encourage healing and to protect it from further
injury. You may need to use elastic wraps, slings, splints, crutches or canes.
- Rest. Avoid activities that increase the pain or swelling. Rest is essential to tissue
healing. But rest doesn't mean complete bed rest. You can do low-impact activities and exercises that
don't stress the injured tissue.
- Ice. To decrease pain, muscle spasm and swelling, apply ice to the injured area. Ice packs,
ice massage or slush baths all can help.
- Compression. Because swelling can result in loss of motion in an injured tendon, compress
the area until the swelling has ceased. Wraps or compressive (Ace) elastic bandages are best.
- Elevation. To reduce swelling, raise the affected leg above the level of your heart. It's
especially important to use this position at night.
Although rest is a key part of treating tendinitis and bursitis, prolonged inactivity can cause stiffness in your joints. After a few days of completely resting the injured area, gently move your ankle through its full range of motion four times a day to maintain joint flexibility.
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen (Advil, Motrin, others) and products containing acetaminophen (Tylenol, others) can help reduce the discomfort associated with tendinitis. But be sure to consult your doctor if you need NSAIDs for an extended time because some should be used for only short periods to avoid complications. The benefits gained from using these drugs long-term is also questionable. If you take them frequently or take more than the recommended dose, NSAIDs can cause nausea, stomach pain, stomach bleeding or ulcers. In rare cases prolonged use can disrupt normal kidney function. The risk of these conditions increases with your age. Individuals with liver problems should consult their physician before using products containing acetaminophen.
|
— March 01, 2002 —