In this blog post Cypress foot and ankle specialist Dr. Christopher Correa discusses Achilles tendon ruptures. The Achilles is the largest and strongest tendon in the body and is essential for activities such as walking, running, and jumping. The tendon itself is a strong and fibrous cord-like structure that connects both heads of the calf muscles (soleus and gastroc) to the heel bone (calcaneus). The Achilles tendon is responsible for transmitting the force generated by the calf muscles to the foot and ankle, allowing for plantarflexion (pointing the toes downward) and providing stability to the ankle joint. Though the Achilles tendon is quite literally the strongest tendon in the body, it still has its own form of “Achilles heel”. (See what I did there?!). The watershed area in the Achilles tendon refers to a region of the tendon that is particularly vulnerable to injury due to poor blood supply making it the most common portion of the tendon to rupture. Injuries to the watershed area can lead to Achilles tendonitis or which is characterized by pain, swelling and scarring which can overtime lead to rupture.
Risk Factors for Achilles Tendon Rupture
The risk factors for Achilles tendon rupture can be divided into modifiable and non-modifiable factors.
Non-modifiable risk factors include:
Age: Achilles tendon ruptures are most common in people between the ages of 30 and 50 years old.
Gender: Men are more likely to experience an Achilles tendon rupture than women.
Genetics: Some people may have genetic predisposition to Achilles tendon rupture due to inherited structural abnormalities in the tendon.
Modifiable risk factors include:
Overuse: Repetitive stress on the Achilles tendon due to overuse, such as excessive running or jumping, can weaken the tendon and increase the risk of rupture.
Poor conditioning: Lack of exercise or conditioning of the calf muscles can make the Achilles tendon more prone to injury.
Obesity: Excess body weight can increase the load on the Achilles tendon and make it more susceptible to injury.
Certain medications: Fluoroquinolone antibiotics and corticosteroids have been associated with increased risk of Achilles tendon rupture.
Smoking: Smoking can impair blood flow to the Achilles tendon and interfere with its ability to heal, increasing the risk of rupture.
Certain medical conditions: Diabetes, high blood pressure, and rheumatoid arthritis have been associated with an increased risk of Achilles tendon rupture.
It is important to take steps to reduce modifiable risk factors to help prevent Achilles tendon injuries, such as maintaining a healthy weight, stretching properly before exercise, wearing appropriate footwear, and avoiding excessive or sudden increases in physical activity.
Symptoms of Achilles Tendon Ruptures
The symptoms of an Achilles tendon rupture can vary in severity, but typically include:
Sudden pain: A sudden and severe pain is often felt in the back of the ankle or calf at the time of injury. Some people report feeling as if they have been struck or kicked in the back of the leg. This pain may be intense at first but reduce quickly in a complete rupture.
Swelling: Swelling around the area of the rupture may occur, making it difficult to put weight on the affected leg. In complete ruptures a lot of swelling and often times bruising can be seen on either side of the tendon.
Difficulty walking: Many people are unable to walk or bear weight on the affected leg after an Achilles tendon rupture initially. After the initial shock of injury wears off many people do quickly regain the ability to walk. It is not uncommon for people to continue walking (or limping), sometimes for weeks, on a rupture Achilles before presenting for a medical evaluation.
Stiffness: Stiffness and limited range of motion in the ankle or calf may be present, making it difficult to flex or point the foot.
Audible popping or snapping sound: Some people may hear a popping or snapping sound at the time of the injury, indicating a possible Achilles tendon rupture.
If you experience any of these symptoms, it is important to seek medical attention right away. A ruptured Achilles tendon is a serious injury that requires prompt diagnosis and treatment to achieve the best possible outcome. Neglected Achilles tendon ruptures can lead to retraction of the tendon making repair more difficult and prolong the recovery period.
Treatment of Achilles Tendon Ruptures
The treatment for Achilles tendon ruptures may vary depending on the severity of the injury, the patient's age, activity level, and other factors. The two main treatment options for Achilles tendon ruptures are:
Non-surgical treatment: This may include immobilization of the ankle with a cast or brace, P.R.I.C.E., and the use of crutches to help with mobility. Non-steroidal anti-inflammatory drugs (NSAIDs) may also be prescribed to help manage pain and swelling. Physical therapy may be recommended to help strengthen the calf muscles and improve range of motion. This is usually limited to patients with minimal gap between tendon edges.
Surgical treatment: Surgery may be recommended for athletes and active individuals, and for those with larger or more complete ruptures. The surgeon may either repair the tendon with sutures, or remove any damaged tissue and then reattach the tendon to the bone. After surgery, a period of immobilization in a cast or brace may be required, followed by physical therapy to help regain strength and mobility in the ankle.
Overall, the goal of treatment for Achilles tendon ruptures is to restore function and prevent re-injury. Early diagnosis and treatment can improve the changes of a full recovery. If you recently suffered any of the symptoms mentioned above and are concerned that you may have an Achilles tendon rupture, DO NOT WAIT. Make an appointment with the experts at Select Foot and Ankle Specialists today and take the first step towards recovery!