Coping With An Achilles Tendon Rupture

Overview
An Achilles tendon rupture is a tear in the strong fibrous cord that connects the muscles in the back of your calf to your heel bone. The tendon can rupture partially or completely. Your Achilles tendon is the largest tendon in the body and plays a critical role. In fact, you rely on it every time you move your foot. The tendon helps you point your foot down, rise on your toes and push off as you walk. An Achilles tendon rupture is a serious injury. If you suspect you have torn your Achilles - especially if you hear a pop or snap in your heel and cannot walk properly - seek medical attention immediately.

Causes
The Achilles tendon usually ruptures as a result of a sudden forceful contraction of the calf muscles. Activities such as jumping, lunging, or sprinting can cause undue stress on the Achilles tendon and cause it to rupture. Often there is a background of Achilles tendinitis. Direct trauma to the area, poor flexibility or weakness of the calf muscles or of the Achilles tendon and increasing age are some of the other factors that are associated with an Achilles tendon rupture.

Symptoms
Symptoms include a sudden sharp pain in the achilles tendon which is often described as if being physically struck by an object or implement. A loud snapping noise or bang may also be heard at the time. A gap of 4 to 5 cm in the tendon can be felt which may be less obvious later as swelling increases. After a short while the athlete may be able to walk again but without the power to push off with the foot. There will be a significant loss of strength in the injured leg and the patient will be unable to stand on tip toes. There may be considerable swelling around the achilles tendon and a positive result for Thompson's test can help confirm the diagnosis.

Diagnosis
Your doctor diagnoses the rupture based on symptoms, history of the injury and physical examination. Your doctor will gently squeeze the calf muscles, if the Achilles tendon is intact, there will be flexion movement of the foot, if it is ruptured, there will be no movement observed.

Non Surgical Treatment
Pain medicines can help decrease pain and swelling. A cast may be needed for 2 months or more. Your foot will be positioned in the cast with your toes pointing slightly down. Your caregiver will change your cast and your foot position several times while the tendon heals. Do not move or put weight on your foot until your caregiver tells you it is okay. A leg brace or splint may be needed to help keep your foot from moving while your tendon heals. Heel lifts are wedges put into your shoe or cast. Heel lifts help decrease pressure and keep your foot in the best position for your tendon to heal. Surgery may be needed if other treatments do not work. The edges of your tendon may need to be stitched back together. You may need a graft to patch the tear. A graft is a piece of another tendon or artificial material.

Surgical Treatment
Operative treatment of Achilles tendon ruptures involves opening the skin and identifying the torn tendon. This is then sutured together to create a stable construct. This can be performed through a standard Achilles tendon repair technique or through a mini-incision technique (to read about the different types of techniques, look under ?Procedure? in Achilles Tendon Repair). By suturing the torn tendon ends together, they maintain continuity and can be mobilized more quickly. However, it is critical to understand that the return to normal activities must wait until adequate healing of the tendon has occurred. The potential advantages of an open repair of the Achilles tendon include, faster recovery, this means that patients will lose less strength. Early Range of Motion. They are able to move the ankle earlier so it is easier to regain motion. Lower Re-rupture Rate. The re-rupture rate may be significantly lower in operatively treated patients (2-5%) compared to patients treated non-operatively (8-15%). The main disadvantage of an open repair of the Achilles tendon rupture is the potential for a wound-healing problem which could lead to a deep infection that is difficult to eradicate, or a painful scar.