Achilles tendon rupture 

First, there's a pop or a snap. Then an immediate sharp pain in the back of your ankle and lower leg makes it impossible to walk properly. It almost feels like you've been kicked, or even shot.

These are the sensations typical of a rupture of your Achilles tendon. This tendon is 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, causing pain or requiring treatment. These include bursitis and tendonitis. Although bursitis and tendonitis often improve with home treatment, a ruptured Achilles tendon usually requires surgical repair.

 

Signs and symptoms

Pain and swelling near your heel and an inability to bend your foot downward or walk 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 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.

If you haven't torn your Achilles tendon, you may be experiencing other conditions involving your Achilles tendon, such as bursitis or tendonitis. Here's how they affect your Achilles tendon:

bulletBursitis. 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. Bursitis is inflammation and irritation of a bursa. Inflammation can occur in the bursa between your heel bone and your Achilles tendon. This type of bursitis is called retrocalcaneal bursitis. 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 cause further irritation.
bulletTendonitis. Achilles tendonitis is inflammation of your Achilles tendon. The pain is the result of tiny tears and inflammation in the tissue of the tendon itself. Tendonitis of the Achilles tendon usually develops at a point just above the attachment point of the tendon to your heel bone. Signs that you may have Achilles tendonitis 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:

bulletOveruse
bulletRunning on hills and hard surfaces
bulletPoor stretching habits
bulletTight calf muscles
bulletWeak calf muscles
bulletWorn-out shoes
bulletFlatfeet

Injuries to your Achilles tendon can often result from taking part in an activity involving stop-and-start footwork for which you're not conditioned or for which you haven't stretched properly. This might include playing tennis, racquetball or basketball for the first time after a long break.

Sometimes, though, injuries can occur from simply overstretching your Achilles tendon in the course of 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 especially if 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 your physical activities and perform an examination of your feet, ankles and legs. If it's clear that 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 the soft tissues of your body.

 

Complications

If Achilles tendonitis is left untreated and the tendon continues to develop multiple small tears through exercise and repeated movement, the tendon can rupture. Untreated Achilles bursitis can lead to increased swelling, pain and disability.

 

Treatment

Treatment for Achilles tendon ruptures can be surgical or nonsurgical.

bulletSurgery. The usual treatment for a complete rupture of an Achilles tendon is surgery. The procedure generally involves making an incision in the back of your lower leg and stitching the torn tendon together. Afterward, you'll need to spend about six to 12 weeks with your leg in a walking boot, cast, brace or splint. To promote healing and to avoid stretching the surgical repair, your foot may initially be pointed slightly downward in the boot or brace, and then moved gradually to a neutral position.
bulletNonsurgical treatment. This approach typically involves wearing a cast or walking boot, which allows the ends of your torn tendon to reattach themselves on their own. This method can be effective, and it avoids the risks, such as infection, associated with surgery. However, the likelihood of re-rupture is higher with a 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 resume strenuous recreational activities. Surgery is generally very effective, and your risk of complications is typically quite low.

Treatment for bursitis and tendonitis of the Achilles tendon is usually a combination of self-care measures. Rarely is surgery necessary. Cortisone injections for these conditions may help some people, but repeated injections may be associated with 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, stretching to the point at which you feel a noticeable pull, but not pain. Don't bounce during a stretch.

 

To further reduce your chance of developing Achilles tendon problems:

bulletAvoid activities that place excessive stress on your heel cords, such as hill-running and jumping activities.
bulletIf you notice pain during exercise, rest.
bulletIf one exercise or activity causes you persistent pain, try another.
bulletAlternate 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:

bulletStand flat, then rise up on your toes.
bulletHold the elevated position momentarily before slowly dropping back down to a stand. Emphasizing the slow return to the ground will help improve the force-absorbing capability of your calf muscle and Achilles tendon.
bulletStart 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 are designed to help you do toe raises. This type of strengthening can be especially helpful if you're recovering from chronic Achilles tendonitis.

To avoid a recurrence of an Achilles tendon injury, follow these guidelines:

bulletUse warm-up and cool-down exercises and calf-strengthening exercises.
bulletApply ice to your Achilles tendon after exercise.
bulletAlternate high-impact sports with low-impact sports, so as not to overwork your Achilles tendons.

 

Self-care

To treat Achilles tendonitis or bursitis at home, remember the acronym P.R.I.C.E. — protection, rest, ice, compression and elevation. This treatment can help speed your recovery and help prevent further injuries when Achilles tendon problems resurface. The elements of P.R.I.C.E. involve the following:

bulletProtection. 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.
bulletRest. Avoid activities that increase the pain or swelling. Rest is essential to allow tissue to heal. But rest doesn't mean complete bed rest. You can participate in low-impact activities and exercises that don't stress the injured tissue.
bulletIce. To decrease pain, muscle spasm and swelling, apply ice to the injured area. Ice packs, ice massage or slush baths all can help.
bulletCompression. Because swelling can result in loss of motion in an injured tendon, compress the area until the swelling has subsided. Wraps or compressive (Ace) elastic bandages are best.
bulletElevation. 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 element in treating tendonitis and bursitis, prolonged inactivity can cause stiffness in your joints. After a few days of completely resting the injured area, begin gently moving 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 tendonitis. But be sure to consult your doctor if you need NSAIDs for an extended time, because some should be used only for short periods to avoid complications. The benefits of using these drugs long term are also questionable. If you use 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.

 

By Mayo Clinic staff