Ruptures Of The Achilles Tendon
The Achilles tendon is the most commonly ruptured tendon in the body. Having a torn Achilles tendon is one of the most devastating injuries which the competitive and recreational athlete can suffer. Overall it is not as common an injury as, for example, tendonitis of the elbow, but it is much more difficult to treat in the higher levels of competitive sports.
Approximately 6% to 18% of athletes suffer from a torn Achilles tendon, which means that the injury affects about a million athletes every year. Injuries to the Achilles tendon are more common in men between the ages of 30-50, although it can also occur at any age in both genders. This can be attributed to the greater participation of men in sports activities compared to women. Most patients rarely do warm-up exercises and are not regularly active.
Although it is not entirely avoidable, there is much that can be done to reduce your chances of suffering such an injury.
How can you prevent your Achilles tendon from rupturing?
Our foot and ankle doctor shared the following tips to help decrease your risk for Achilles tendon injury and rupture:
Never skip your warm-up exercises
Failing to do proper stretches and calf-strengthening exercises before training and playing can increase your risk for injury. Stretching your calf until you feel a pull trains your Achilles tendon to absorb more stress and tension.
Add variation to your work-outs
Doing a combination of low-impact and high-impact exercises can prevent overuse injuries that create microtears in your muscles and tendons.
Gear up and take precautions when training
Always wear the proper training gear during training and even when exercising. Choose clothes and footwear that fit you well, and always consider the weather when choosing what to wear and where to train.
Pace the intensity of your training
Any abrupt changes in training intensity may lead to injuries. Give your body time to recover by slowly increasing your workouts' intensity, duration, and frequency to a maximum of 10% every week.
Proper nutrition and hydration
Strengthen your muscles, bones, and tendons by eating protein-rich and nutritious foods.
It is obvious that the best thing to do with an Achilles tendon rupture is to avoid it in the first place. This can be done very simply with stretching exercises prior to the workout.
All stretching exercises, whether they are done for the Achilles tendon or any other muscle group in the body, should be done with the speed of a glacier; that is to say that they should not be rapid twisting motions or pumping motions up and down.
The affected area should be put on a stretch and then held for 15 seconds just below the feeling of discomfort. The best way to determine exactly how much of a stretch should be put on a limb is strained but still comfortable. The stretch should be held for 15 seconds and repeated several times prior to workout if the best results are to be obtained. This also promotes flexibility as well as protecting the tendon from injury.
How and why do Achilles tendons rupture?
First, it is necessary to understand the anatomy of the area. The tendo calcaneus (Achilles tendon) is the thickest and strongest tendon in the human body. It is approximately 15 cm long and begins in the mid-aspect of the calf, and extends distally (towards the foot) to its insertion on the heel bone (calcaneus).
It actually originates from three separate muscles that join together to form the strong muscular group responsible for pushing the foot downward to provide the push-off for propelling the body forward. This is especially accentuated in sports such as squash, where a rapid push-off is required. It is obvious, therefore, that when this tendon ruptures, it is a major injury.
Unfortunately, it can particularly affect athletes. It may simply occur as they are pushing off to reach forward, although it has been known to occur when the athlete is simply in the ready position anticipating forward movement.
How do you know if your Achilles tendon is torn or ruptured?
You might have a ruptured Achilles tendon if you experience any of the following signs and symptoms:
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Feeling like someone kicked you in the calf
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Severe pain and swelling in the area near the heel
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Hearing a popping sound before or at the onset of sharp pain in the lower leg
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Can't stand on the toes
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Can't bend the foot downward
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Can't push the foot forward when walking
The classic story is that the athlete feels a sudden pain in or just below the calf and, due to the sudden nature of the pain and the sensation of a direct blow, turns around to see who hit him with the tennis ball. The sudden pain should stop the play immediately, and medical attention should be sought without delay.
First-aid treatment for a ruptured Achilles tendon
The RICE method is a simple first-aid treatment for musculoskeletal injuries. These measures can only minimize the symptoms and prevent further injury, but they cannot treat the ruptured tendon. Do the following these steps until medical help arrives:
- R - Rest and avoid putting weight on the injured leg.
- I - Apply a cold pack on the injury to reduce pain and swelling.
- C - Compress and stabilize the affected area by wrapping it securely with an elastic bandage.
- E - Elevate the injured leg above the level of the heart to further ease the swelling.
A patient who suffered from a torn or ruptured Achilles tendon should see a foot and ankle doctor as soon as possible.
How is an Achilles tendon rupture diagnosed?
Physical examination
To diagnose a ruptured Achilles tendon, an orthopedic doctor would need to assess the affected area. Patients usually complain of pain, tenderness, and swelling on the injured leg. If a tendon is completely ruptured, the doctor may feel a gap during palpation.
Simmonds-Thompson Test
There is a simple test used to determine if there is an injury to the Achilles tendon. This is called the Simmonds-Thompson test. During this test, the doctor would ask you to lie on your stomach or kneel on a chair with the injured leg hanging over the end of the examination table or chair. Then, the doctor would gently squeeze your calf muscles and observe your reaction.
Normally, this should cause the patient to flex their foot automatically. If the foot remains stationary, the doctor will suspect a ruptured Achilles tendon.
Laboratory tests
You would need to undergo further tests, such as an ultrasound or MRI, to verify the diagnosis and know the extent of your injury.
Treatment options for a ruptured Achilles tendon
There are 3 treatment options for Achilles tendon rupture:
- Nonsurgical treatment, which includes casting and immobilization
- Surgical treatment to reconnect the torn tendon
- Rehabilitation to gradually bring back the strength of the tendon and muscles
Because every case and patient is unique, the medical and surgical treatment is controversial at times. This is mostly related to the fact that treatment is complex, and there is no one simple answer to the problem. The leg can either be operated on or casted for a prolonged period of time, and there are proponents of both types of treatment.
However, with either treatment there is a long period of casting and immobilization of up to ten weeks with a long and arduous course of physiotherapy after the casting is over.
Surgical repair is most commonly advocated for the more distal (lower) injuries which are closer to the insertion on the calcaneus (heel bone). Often, at higher levels of competition, it is a career-ending injury in spite of vigorous surgical or casting treatment. Although the athlete can recover, they rarely attain the high level of sport they were at prior to the injury.
By far, the best treatment for this injury is prevention itself. Although the stretching exercises may take a few minutes, they are well worth the effort and should be part of every athlete's warm-up to avoid this devastating injury.
Answers to common questions about Achilles tendon ruptures
Q
How long does it take to recover from Achilles tendon rupture?
A torn tendon may take 2 months to heal. Depending on the injury, it may take patients 4 to 12 months before they can return to playing sports.
Q
Can you still walk with a torn Achilles tendon?
Some patients can still manage to walk, move the ankle, and stand on both tiptoes. It's a little tricky to diagnose since not all patients have a palpable gap in the injured tendon. For these reasons, the foot and ankle doctor performs the calf squeeze test and orders imaging tests to avoid missing a diagnosis.
Q
Do I need surgery for a ruptured Achilles tendon?
Although both surgery and immobilization can successfully treat the injury, the risk of reinjury is higher after immobilization than after surgery. If you are into sports, young, and physically active, surgery may be the best option for you.
Where to find an orthopedic sports medicine doctor near me?
If you think you might be suffering from a torn Achilles tendon, don't hesitate to visit Pinnacle Orthopaedics. We have five convenient locations and a team of qualified and experienced sports medicine doctors to cater to an athlete's needs:
If you would like more information about orthopedic sports medicine, do not hesitate to contact us! Schedule an appointment with one of our qualified physicians today.
Resources
- Olecranon Bursitis
- Osteochondritis Dissecans (OCD)
- Patellofemoral Syndrome
- Plantar Fascitis (Heel Spurs)
- Ruptures Of The Achilles Tendon
- Shoulder Impingement, Bursitis & Tendonitis
- Shoulder Instability
- Shoulder Pain
- Stingers
- Tendonitis (Tennis Elbow)
- Total Knee Replacement
- Trigger Finger
- Total Hip Replacement