Overview
The Achilles tendon is an important part of the leg. It is located just behind and above the heel. It joins the heel bone to the calf muscles. Its function is to help in bending the foot downwards at the ankle (this movement is called plantar flexion by doctors). If the Achilles tendon is torn, this is called an Achilles tendon rupture. The tear may be either partial or complete. In a partial tear, the tendon is partly torn but still joined to the calf muscle. With complete tears, the tendon is completely torn so that the connection between the calf muscles and the ankle bone is lost.
Causes
Causes of and contributors to Achilles tendon rupture include trauma (caused by injury, usually an acceleration injury such as pushing off or jumping up). Preceding tendon problems. Chronic Achilles tendonitis (can lead to small tears within the tendon, increasingly weakening it). Certain drug therapies/treatments. Drugs that have been linked to Achilles tendon rupture include. Fluoroquinolone antibiotics - after nearly 900 reports of tendon ruptures, tendonitis and other tendon disorders (most associated with the Achilles tendon) linked to Ciprofloxacin (Cipro) alone were collected in the U.S. Food and Drug Administration (FDA)?s database, at least one public-interest group petitioned the FDA to recommend that a "Black Box Warning" be added to Cipro's packaging. Some researchers speculate this class of antibiotics is toxic to tendon fibers, and that in some cases may reduce their blood supply. Patients should at least be more aware of the potential for ruptures so that they can be switched to other antibiotics at the onset of early warning signals such as tendon pain.
Symptoms
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.
Diagnosis
Some patients mistakenly believe the tendon is working if they can push the foot down, however, patients will usually be able to move the foot up and down while sitting because the other surrounding muscles and tendons are still intact. Trying to push up while standing and applying body weight to the foot will reveal the true weakness. Sensation and circulation to the foot and ankle will be normal. In addition, x-rays will be normal unless the Achilles injury involves pulling off (avulsion) of the bone on the calcaneus (heel bone). This is quite rare, occurring in only a small fraction of patients with Achilles injuries. Patients suffering this type of Achilles avulsion injury tend to be older with weaker bone. Imaging Studies. Plain x-rays will be negative in patients who have suffered an Achilles tendon rupture. The rupture can be seen on ultrasound or MRI. However, these studies are not indicated for acute ruptures unless there is some uncertainty about the diagnosis. For chronic problems of the Achilles or ruptures that are old, an MRI may be very helpful.
Non Surgical Treatment
If you suspect a total rupture of the achilles tendon then apply cold therapy and compression and seek medical attention as soon as possible. In most cases surgery is required and the sooner this takes place the higher the chances of success. If the injury is left longer than two days then the chances of a successful outcome decrease. Cold and compression can also be applied throughout the rehabilitation phase as swelling is likely to be an issue with such a serious injury.
Surgical Treatment
Some surgeons feel an early surgical repair of the tendon is beneficial. The surgical option was long thought to offer a significantly smaller risk of re-rupture compared to traditional non-operative management (5% vs 15%). Of course, surgery imposes higher relative risks of perioperative mortality and morbidity e.g. infection including MRSA, bleeding, deep vein thrombosis, lingering anesthesia effects, etc.
The Achilles tendon is an important part of the leg. It is located just behind and above the heel. It joins the heel bone to the calf muscles. Its function is to help in bending the foot downwards at the ankle (this movement is called plantar flexion by doctors). If the Achilles tendon is torn, this is called an Achilles tendon rupture. The tear may be either partial or complete. In a partial tear, the tendon is partly torn but still joined to the calf muscle. With complete tears, the tendon is completely torn so that the connection between the calf muscles and the ankle bone is lost.
Causes
Causes of and contributors to Achilles tendon rupture include trauma (caused by injury, usually an acceleration injury such as pushing off or jumping up). Preceding tendon problems. Chronic Achilles tendonitis (can lead to small tears within the tendon, increasingly weakening it). Certain drug therapies/treatments. Drugs that have been linked to Achilles tendon rupture include. Fluoroquinolone antibiotics - after nearly 900 reports of tendon ruptures, tendonitis and other tendon disorders (most associated with the Achilles tendon) linked to Ciprofloxacin (Cipro) alone were collected in the U.S. Food and Drug Administration (FDA)?s database, at least one public-interest group petitioned the FDA to recommend that a "Black Box Warning" be added to Cipro's packaging. Some researchers speculate this class of antibiotics is toxic to tendon fibers, and that in some cases may reduce their blood supply. Patients should at least be more aware of the potential for ruptures so that they can be switched to other antibiotics at the onset of early warning signals such as tendon pain.
Symptoms
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.
Diagnosis
Some patients mistakenly believe the tendon is working if they can push the foot down, however, patients will usually be able to move the foot up and down while sitting because the other surrounding muscles and tendons are still intact. Trying to push up while standing and applying body weight to the foot will reveal the true weakness. Sensation and circulation to the foot and ankle will be normal. In addition, x-rays will be normal unless the Achilles injury involves pulling off (avulsion) of the bone on the calcaneus (heel bone). This is quite rare, occurring in only a small fraction of patients with Achilles injuries. Patients suffering this type of Achilles avulsion injury tend to be older with weaker bone. Imaging Studies. Plain x-rays will be negative in patients who have suffered an Achilles tendon rupture. The rupture can be seen on ultrasound or MRI. However, these studies are not indicated for acute ruptures unless there is some uncertainty about the diagnosis. For chronic problems of the Achilles or ruptures that are old, an MRI may be very helpful.
Non Surgical Treatment
If you suspect a total rupture of the achilles tendon then apply cold therapy and compression and seek medical attention as soon as possible. In most cases surgery is required and the sooner this takes place the higher the chances of success. If the injury is left longer than two days then the chances of a successful outcome decrease. Cold and compression can also be applied throughout the rehabilitation phase as swelling is likely to be an issue with such a serious injury.
Surgical Treatment
Some surgeons feel an early surgical repair of the tendon is beneficial. The surgical option was long thought to offer a significantly smaller risk of re-rupture compared to traditional non-operative management (5% vs 15%). Of course, surgery imposes higher relative risks of perioperative mortality and morbidity e.g. infection including MRSA, bleeding, deep vein thrombosis, lingering anesthesia effects, etc.