A rupture of the Achilles tendon means that there has been either a complete, or partial, tear of the tendon which connects the calf muscles to the heel bone. Usually this occurs just above insertion
on the heel bone, although it can happen anywhere along the course of the tendon. Achilles tendon rupture occurs in people that engage in strenuous activity, who are usually sedentary and have
weakened tendons, or in people who have had previous chronic injury to their Achilles tendons. Previous injury to the tendon can be caused by overuse, improper stretching habits, worn-out or
improperly fitting shoes, or poor biomechanics (flat-feet). The risk of tendon rupture is also increased with the use of quinolone antibiotics (e.g. ciprofloxacin, Levaquin).
As with any muscle or tendon in the body, the Achilles tendon can be torn if there is a high force or stress on it. This can happen with activities which involve a forceful push off with the foot,
for example, in football, running, basketball, diving, and tennis. The push off movement uses a strong contraction of the calf muscles which can stress the Achilles tendon too much. The Achilles
tendon can also be damaged by injuries such as falls, if the foot is suddenly forced into an upward-pointing position, this movement stretches the tendon. Another possible injury is a deep cut at the
back of the ankle, which might go into the tendon. Sometimes the Achilles tendon is weak, making it more prone to rupture. Factors that weaken the Achilles tendon are as follows. Corticosteroid
medication (such as prednisolone) - mainly if it is used as long-term treatment rather than a short course. Corticosteroid injection near the Achilles tendon. Certain rare medical conditions, such as
Cushing's syndrome, where the body makes too much of its own corticosteroid hormones. Increasing age. Tendonitis (inflammation) of the Achilles tendon. Other medical conditions which can make the
tendon more prone to rupture; for example, rheumatoid arthritis, gout and systemic lupus erythematosus (SLE), lupus. Certain antibiotic medicines may slightly increase the risk of having an Achilles
tendon rupture. These are the quinolone antibiotics such as ciprofloxacin and ofloxacin. The risk of having an Achilles tendon rupture with these antibiotics is actually very low, and mainly applies
if you are also taking corticosteroid medication or are over the age of about 60.
The most common symptom of Achilles tendonitis is a sudden surge of pain in the heel and back of the ankle at the point of injury which is often described as a snapping sensation in the heel. After
the injury has occurred, patients then struggle or find it near impossible to bear any weight on the affected leg. Pain can often be most prominent first thing in the morning after the injury has
been rested. Swelling and tenderness is also likely to appear in the area.
During the physical exam, your doctor will inspect your lower leg for tenderness and swelling. In many cases, doctors can feel a gap in your tendon if a complete rupture has occurred. Achilles tendon
rupture can be diagnosed reliably with clinical examination, but if there?s a question about the extent of your Achilles tendon injury then your doctor may order a magnetic resonance imaging (MRI)
Non Surgical Treatment
The most widely used method of non-surgical treatment involves the use of serial casting with gradual progression from plantar flexion to neutral or using a solid removable boot with heel inserts to
bring the ends of the tendon closer together. The advantage of a solid removable boot is that it allows the patient to begin early motion and is removable. Wide variability exists among surgeons in
regards to the period of absolute immobilization, initiating range of motion exercises, and progression of weight bearing status.
A completely ruptured Achilles tendon requires surgery and up to 12 weeks in a cast. Partial tears are sometimes are treated with surgery following by a cast. Because the tendon shortens as it heals,
a heel lift is used for 6 months or more after the cast comes off. Physical therapy to regain flexibility and then strength are begun as soon as the cast is off.