30 Nov Achilles Tendon Tear
An Achilles tendon tear is a common injury that involves a complete tear of the tendon attaching the calf muscle to the heel. This type of injury is most commonly seen in middle-aged males who perform rigorous physical activity.
The Achilles tendon is the largest tendon in the body. Given that it is directly beneath the skin (subcutaneous) in much of its course and is involved in weight-bearing and strenuous activities, it is prone to injury. When large forces are exerted with sudden, explosive movements, it can compromise the physical integrity of the Achilles tendon.
Men are about 7 times more likely to tear their Achilles, especially when running or jumping and often occurs without any contact or collision. Certain antibiotics (fluoroquinolones) and cortisone shots may make it more likely to tear the Achilles tendon. It is for this reason that cortisone shots are not prescribed for Achilles tendonitis.
An Achilles tendon tear is a traumatic injury and causes sudden pain behind the ankle. There may be a ‘pop’ or a ‘snap’ sound. There is loss of the ability to point the toes downward, and there may be swelling and bruising around the tendon.
On physical examination, there is a palpable defect in the Achilles tendon can often be felt through the skin. Squeezing the calf muscle will not cause any foot movement (normally, the foot points downwards); this is known as the positive Thompson’s test. X-rays are generally performed to evaluate for an associated ankle fracture or ankle arthritis.
About 15 to 20% of patients have preexisting (likely undiagnosed) Achilles tendonitis prior to sustaining an Achilles tendon tear, but most of the patients have no prior or existing issues. Over 75% of Achilles tendon tears are associated with playing basketball or tennis.
Gout also predisposes to Achilles tendon tear.
Immediate management includes RICE.
- Rest – Stay off the injured foot and ankle as weight-bearing or walking can cause pain or further damage.
- Apply an ice pack to reduce pain and swelling.
- Wrap the foot and ankle in an elastic bandage to prevent further swelling.
- Keep the leg elevated to reduce the swelling.
Definitive treatment of an Achilles tendon tear can be either surgery or non-surgical. Surgery may be preferred because it is associated with less immobilization. Athletes especially prefer that as it allows them to get back to sports faster. There is also a lesser chance re-rupture of the Achilles tendon this way. Alternatively, the primary advantage of non-surgical treatment is that the potential surgical risks are avoided Furthermore, the long-term functional results are similar to those of surgical treatment.
Whether treated surgically or nonsurgically, physical therapy is an important component of the treatment process. It involves exercises that strengthen the muscles and improve range of motion in the foot and ankle, and speed up the recovery process and resumption of strength in the muscle/tendon.