Reviewed by DR. D. DATTA.
Ex. Emergency Medical Officer.
Tendon is a fibrous band of connective tissue that connects muscles with a bone.
In the posterior aspect of the upper part of leg there are two calf muscles (gastrocnemius and soleus), at the lower part of the leg they unite to form a band of fibrous tissue that is called achilles tendon.
The achilles tendon is inserted into the heel bone (calcaneus also called calcaneum). A small sac of fluid called retrocalcaneal bursa is present above the insertion of the tendon in between the heel bone and tendon. Another bursa present behind the tendon and the skin is called subcutaneous calcaneal bursa. These bursae protect the tendon against rubbing with the heel bone.
With the help of this tendon
1 The heel is lifted off the ground.
2 This tendon is involved in activities such as Walking, climbing stairs, standing on toe tips, Running and jumping.
It is the strongest, largest and longest tendon in the body, 6 to 10 inches long.
This tendon is strong enough to bear 4 times of one’s body weight. But this tendon is poorly supplied with blood.
Tearing and separation of fibers of the achilles tendon is called achilles tendon rupture. Rupture usually occurs in the tendon itself 4 to 6 cm above the heel, but may also occur at its point of insertion with the heel bone. As a result, the tendon cannot work properly. Achilles tendon is the most commonly ruptured tendon.
Incidence in general people is 7 per 100000 per year, but in athletes it is 15 to 20 per 100000 per year. Achilles tendon rupture is common in 30 to 50 years of age group.
It is more common in male than females (20:1 ratio).
Symptoms of achilles tendon rupture
Sometimes there may be no signs and symptoms of achilles tendon rupture but most patients may have the following symptoms.
1 There may be an audible crack, followed by sudden severe pain in the back of the lower leg. The patients may feel that they have been kicked in the calf.
2 Tenderness of the back of heel at the site of injury.
3 Swelling near the heel.
4 You may feel a gap on palpation at the site of injury.
4 Restricted downward movement of the foot.
5 Patient cannot stand on toes.
There may be prior history of achilles tendinosis or steroid injection.
Test to diagnose achilles tendon rupture
Thompson test also called Simmonds test (calf squeeze test)- Bend your knees in kneeling position on a chair or in a prone position on a bed with ankle and feet unsupported. Then your doctor will squeeze the calf muscles. If the tendon is intact, then there will be plantar flexion movement of the foot and if there is fresh achilles tendon rupture there will be no movement.
Imaging- sometimes non-invasive tests such as MRI and Ultrasound may be done to create images of the tendon.
Causes of achilles tendon rupture
Usually, it is sports related injury but it can happen to anyone.
1 Main cause is sudden overstretching of the heel.
2 Fall from height.
Risk factors of achilles tendon rupture
1 Obesity.
2 Use of some medicines such as fluoroquinolone and steroids.
3 Natural aging.
4 Using improper shoes during sports activities.
5 Flat foot (pes planus), high arch foot (pes cavus) and discrepancy between two legs.
Treatment of achilles tendon rupture
Non-operative- Immobilization of the leg in a position of foot and ankle flexed downwards by a cast so that torn ends of the tendon come closer and normal healing takes place.
Operative treatment- Complete rupture with tendinous gap less than 3 cm treated with end-to-end sutures. Two ends of the tendon are mobilized and sutured together. Then the leg is immobilized by a splint or cast for 6 to 12 weeks.
When tendon healing occurs, physical therapy starts.
In case of neglected complete rupture and the gap becomes more than 6 cm then tendon or synthetic graft may be necessary.
Surgical procedure is also preferred in young age and athletes. Surgical procedure reduces the chance of re rupture.
Achilles tendon rupture recovery time
The recovery time for an Achilles tendon rupture can vary depending on various factors, including the severity of the injury and the individual’s overall health. Generally, it takes about 6 to 12 months to fully recover from an Achilles tendon rupture. In the initial stages, the affected leg is typically immobilized in a cast or walking boot for several weeks to promote healing. Physical therapy is a crucial part of the recovery process, helping to rebuild strength, flexibility, and range of motion. As the healing progresses, gradual return to normal activities and sports can be expected, but patience and adherence to the rehabilitation plan are key for a successful recovery.
Life after achilles tendon rupture
Life after an Achilles tendon rupture can be challenging but with proper treatment and rehabilitation, individuals can regain their mobility and lead active lives. The recovery process involves several stages, starting with immobilization in a cast or walking boot, followed by physical therapy to rebuild strength and flexibility. As healing progresses, gradual return to normal activities and sports is possible, though it may take several months to a year to fully regain pre-injury abilities.
Adapting to life after an Achilles tendon rupture may require making certain lifestyle adjustments. It is important to listen to the body and not push too hard too soon, as this can lead to reinjury. Engaging in low-impact exercises, such as swimming or cycling, can help maintain fitness while reducing stress on the Achilles tendon.
Additionally, wearing appropriate footwear with proper arch support and cushioning can provide stability and minimize strain on the tendon. Regular stretching and strengthening exercises for the calf muscles can also help prevent future injuries.
While an Achilles tendon rupture can be a setback, with time, patience, and a comprehensive rehabilitation program, individuals can regain their mobility and return to an active and fulfilling life.
Achilles tendinitis.
Achilles tendinosis.
Retrocalcaneal bursitis.
Achilles paratenonitis.
