Definition

Achilles tendon rupture is a condition where a tear occurs in the achilles tendon. A tendon is a strong connective tissue that connects muscles to bones. The achilles tendon is one of the largest and strongest tendons in the body, with a thick structure. It connects the calf muscles to the heel bone, allowing you to walk, run, and jump.

Despite its strength and thickness, the achilles tendon can tear, especially when it is overstretched. The tear can affect part or all of the tendon. achilles tendon rupture is most likely to occur when you jump high. When jumping, your foot pushes forcefully against the ground, exerting a strong pressure on the tendon. If the achilles tendon cannot withstand this pressure or is overstretched beyond its capacity, a rupture can occur.

achilles tendon rupture is common and one of the most frequent sports injuries. Each year, there are approximately 18 cases per 100 people. This condition most often affects athletes, with an estimated 1 million athletes experiencing achilles tendon ruptures annually. Among athletes, soccer players are less likely to suffer from this condition compared to tennis players and gymnasts.

Causes

Achilles tendon rupture can be caused by several factors, such as:

• Sudden movements in the foot area that put pressure on the achilles tendon, such as:
• Irregular exercise followed by sudden stopping
• Incidents like tripping, skipping a step when going downstairs, or spraining an ankle
• Direct trauma or injury to the achilles tendon
• Long-term inflammation of the tendon

Risk Factor

The risk of achilles tendon rupture increases in the following groups and conditions:

• Most common in individuals aged 30-50
• Male gender
• Being overweight or obese increases pressure on the tendon when walking or running
• Aging
• Previous damage to the achilles tendon, either from inflammation or overuse of the foot
• Sudden increases in exercise intensity
• Use of steroids (anti-inflammatory) and antibiotics (fluoroquinolones)
• Other health conditions such as high uric acid, inflammatory diseases, and diabetes, which can weaken the achilles tendon
• Wearing inappropriate footwear for the sport or physical activity you're doing
• Starting a new type of exercise
• Having flat feet, which can increase stretching of muscles and tendons when stepping
• Wearing high-heeled shoes, which puts pressure on the tendon
• Changes in running surfaces, such as from grass to concrete

If you are interested in reading further about flat foot, you can read about them here: Pes Planus - Definition, Causes, and Risk Factor.

Symptoms

The most characteristic sign and symptom of achilles tendon rupture is a popping or snapping sensation in the ankle. Other symptoms may include:

• Sudden sharp pain at the back of the foot near the heel or ankle
• A popping sound or sensation
• Increasing pain when moving
• Swelling and bruising around the foot
• A tender spot at the ruptured tendon
• Inability to stand on tiptoe
• Difficulty bending the foot or raising the toes

Diagnosis

To diagnose an achilles tendon rupture, the doctor will ask about your symptoms, when the injury occurred, and how it happened.

A physical examination of the foot will be conducted, where the doctor will assess for swelling and bruising. The doctor will also check your ability to stand, move your foot in all directions, and whether you can place weight on the foot. The achilles tendon at the back of the foot will be examined to assess for injury or tear. The leg will also be examined to check for muscle contractions in the calf and foot.

To confirm the achilles tendon rupture and visualize the bones and soft tissues in the foot, additional tests may be performed. The doctor may recommend imaging tests such as ultrasound, MRI (Magnetic Resonance Imaging), or X-ray.

If you are interested in reading an article about bone fractures, you can read it here: Fractures - Definition, Causes, and Risk Factors.

Management

Before seeking medical care for an achilles tendon injury, you can administer first aid to reduce pain and swelling by following these steps:

• Rest the injured foot.
• Apply a cold compress to the ankle.
• Use an elastic bandage to prevent further swelling.
• Elevate the foot with a pillow or other support to reduce swelling.
• Over-the-counter pain relievers can be taken to help alleviate pain.

Healing a ruptured achilles tendon typically takes about 4-6 months after therapy. Medical treatments to repair the tear include:

• Plaster cast

The use of braces and casts can help keep the foot fixed in a resting position, allowing the torn ends of the achilles tendon to heal.

• Surgery

Surgical repair is usually recommended for active individuals, such as athletes, and younger patients. The torn ends of the tendon are sewn back together, and a cast is applied post-surgery to allow the tendon to rest during the healing process.

• Physical therapy

Physical therapy aims to help restore the function of the achilles tendon, increase muscle strength, and improve the range of motion in the foot and ankle. It is a vital component of achilles tendon rupture treatment and recovery.

Complications

Complications following an achilles tendon rupture include:

• Scar tissue formation on the tendon
• Muscle weakness
• Reduced range of motion
• Worsening pain
• Difficulty walking
• Risk of re-rupturing the tendon
• Post-surgical complications such as skin peeling, wound infection, nerve damage, and scar tissue formation

Prevention

Preventative steps to reduce the risk of achilles tendon rupture include:

• Stretching and warming up before exercise and cooling down afterward
• Maintaining an ideal weight to reduce the load on the achilles tendon
• Wearing well-fitted footwear for sports or physical activity
• Gradually increasing the frequency and intensity of exercise
• Avoiding sudden, intense exercise
• Performing calf stretches and strengthening exercises to enhance the achilles tendon’s strength

When to See a Doctor?

If you experience a foot injury accompanied by sharp pain and a popping sensation, it is advisable to seek immediate care at the nearest Emergency Department.

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