The Achilles tendon is the large cord like structure on the back of the leg just above the heel. It is the largest tendon in the body and has a tremendous amount of force transmitted through it
during walking, running and jumping activities. The Achilles tendon is prone to injury, including rupture during periods of increased stress and activity. Common activities causing injury include
running, basketball, baseball, football, soccer, volleyball and tennis. These activities require jumping and pushing forces that are possible due to the strength of the calf musculature and the
ability of the Achilles tendon to endure this stress. Men from the ages of 30-50 are the most commonly injured during weekend athletic activities.
The most common cause of a ruptured Achilles' tendon is when too much stress is placed through the tendon, particularly when pushing off with the foot. This may happen when playing sports such as
football, basketball or tennis where the foot is dorsiflexed or pushed into an upward position during a fall. If the Achilles' tendon is weak, it is prone to rupture. Various factors can cause
weakness, including corticosteroid medication and injections, certain diseases caused by hormone imbalance and tendonitis. Old age can also increase the risk of Achilles' tendon rupture.
Typically patients present with sudden onset of pain and swelling in the achilles region, often accompanied by a audible snap during forceful dorsiflexion of the foot. A classic example is that of an
unfit 'weekend warrior' playing squash. If complete a defect may be felt and the patient will have only minimal plantar flexion against resistance.
Other less serious causes of pain in the back of the lower leg include Achilles tendonitis or bursitis. To distinguish between these possibilities, your physician will take a thorough history and
examine your lower leg to look for signs of a rupture. The presence of a defect in the tendon that can be felt, evidence of weakness with plantarflexion, and a history consistent with Achilles tendon
rupture are usually sufficient for diagnosis. Your physician may also perform a ?Thompson test,? which consists of squeezing the calf muscles of the affected leg. With an intact Achilles tendon, the
foot will bend downward; however, with a complete rupture of the tendon, the foot will not move. In cases where the diagnosis is equivocal, your physician may order an MRI of the leg to diagnose a
rupture of the Achilles tendon.
Non Surgical Treatment
Achilles tendon ruptures can be treated non-operatively or operatively. Both of these treatment approaches have advantages and disadvantages. In general, younger patients with no medical problems may
tend to do better with operative treatment, whereas patients with significant medical problems or older age may be best served with non-operative treatment. However, the decision of how the Achilles
tendon rupture is treated should be based on each individual patient after the advantages and disadvantages of both treatment options are reviewed. It is important to realize that while Achilles
tendon ruptures can be treated either non-operatively or operatively, they must be treated. A neglected Achilles tendon rupture (i.e. one where the tendon ends are not kept opposed) will lead to
marked problems of the leg in walking, which may eventually lead to other limb and joint problems. Furthermore, late reconstruction of non-treated Achilles tendon rupture is significantly more
complex than timely treatment.
The goal of surgery is to realign the two ends of the ruptured tendon to allow healing. There are multiple techniques to accomplish this goal that will vary from surgeon to surgeon. Recovery from
this injury is usually very successful with return to full function in approximately 6 months. Post operatively casting is required with the use of crutches or other means to remain non-weightbearing
for 4-8 weeks. This is followed by a course of physical therapy. Partial rupture may or may not require surgical intervention depending on the extent of injury but cast immobilization is a common
Good flexibility of the calf muscles plays an essential role in the prevention of Achilles tendon injuries. It is also important to include balance and stability work as part of the training
programme. This should include work for the deep-seated abdominal muscles and for the muscles that control the hip. This might at first appear odd, given the fact that the Achilles are a good
distance from these areas, but developing strength and control in this area (core stability) can boost control at the knee and ankle joints. Training errors should be avoided. The volume, intensity
and frequency of training should be monitored carefully, and gradually progressed, particularly when introducing new modes of training to the programme. Abrupt changes in training load are the
primary cause of Achilles tendinopathy.