Rupture of the Achilles tendon is a common injury in healthy, young and active individuals.The rupture is spontaneous.Rupture of the Achilles tendon occurs just a few centimeters above the heel bone. Achilles tendon rupture is described as an abrupt break with instantaneous pain which is felt in the foot or heel area. The pain may radiate along the back of the leg and is often intense.
Sometime the tendon does not fully rupture but only a partial tear develops. The Achilles tendon rupture occurs just above the heel but it may occur anywhere along the length of the tendon.Common causes of Achilles tendinitis or rupture include advanced age, poor conditioning and overexertion during exercise. In most of the cases the individual rapidly performs activity like running or standing on the toes which generates intense force on the tendon leading to the rupture of the tendon.Age/sex prevalence of Achilles tendon rupture
It is commonly observed in an individual who is 24-45 years of age. It is more common in men but the incidence of Achilles tendon injury is increasing in the population.Injury to the Achilles tendon is most common in the athlete.
• Excessive activity or overuse.
• Flat feet
• Poorly fitting or inadequate shoes.
• Inadequate warm up.
• Jogging or running on hard surfaces.
• Older recreational athlete.
• Previous Achilles tendon injury.
• Repeated steroid injections.
• Sudden changes in intensity of exercise.
• Trauma to the ankle.
• Use of antibiotics
• Tense calf muscles prior to exercise.
• Weak calf muscles.
1) Patient complaining of a sudden snap in the back of the leg. The pain is often intense.
2) Swelling around the calf may occur.
3) With a complete rupture, people will not be able to climb stairs, run or stand on their toes.
When an Achilles tendon rupture occurs the clinical confirmation of tenderness and bruising around the heel. A gap is felt when the finger is passed over the heel area where the rupture has developed. The individual with full blown rupture of the tendon are unable to stand on their toes.
The three common radiological tests to diagnose Achilles tendon rupture are –
1) X-ray - X-ray of the foot reveals swelling of the soft tissues around the ankle, other bone injury or tendon calcification.
2) Ultrasound – For partial tear of the Achilles tendon the diagnosis can be done by ultrasound. It is a relatively inexpensive, fast and reliable test.
3) MRI – It is an excellent imaging test to assess for presence of any soft –tissue trauma or fluid collection. MRI can help to detect the presence of tendon thickening, bursitis and partial tendon rupture.
For complete tear of the tendon surgery is recommended. For partial tear, non surgical treatment is recommended. Selection of treatment depends on the patient, age, level of activity and other risk factors.
If a complete rupture of the Achilles tendon is treated by non- surgically, the risk of rupture is anywhere from 20% -40%. Other complications are skin sloughing, wound infection, nerve damage and protracted recuperation period.
To prevent Achilles tendonitis the following tips are –
• Avoid activities which have enormous stress on the heel.
• Stop all the activity if there is pain at the back of the heel.
• Wear proper shoes.
• Gradually strengthen calf muscles with sit –ups.
• Always warm up with stretching exercise before any activity.
When proper treatment and rehabilitation are undertaken, the prognosis is excellent .However those undergo non surgical care should be aware of recurrence of tendon rupture is higher than surgical therapy. One who develop pain at the back of the heel during sporting activities, it is highly recommended that one should wear proper fitting shoes and discontinue the exercise if pain persists.