Achilles Rupture and Tears

The Achilles tendon connects the two large muscles of your calf to the heel bone. Despite being the toughest tendon in the human body, the Achilles is the most frequently ruptured tendon in the human body with more and more cases diagnosed in the United States every day. The tendon typically ruptures at its narrowest point, approximately 5 cm (2 inches) above its insertion into the heel bone.

What are the causes of Achilles tendon tears?

The classical patient is a “weekend warrior” in the 30-to-50-year-old range who plays sports only once or twice per week rather than spreading it out evenly over the week. Sports mostly linked to Achilles tendon rupture include tennis, volleyball, running, basketball, pickleball, and soccer.

Achilles tendon injury can be a sum of two or more factors that may happen suddenly or weaken the tendon over time. These factors may be local or systemic affecting various parts of your body, including the Achilles tendon, such as:

  • Following a sudden, forced plantarflexion of your ankle (a movement of your foot so that the toes point downward)
  • Following an injury after a strong push-off during jumping or sprinting that forces your toes to point upwards beyond their maximal capacity
  • Not warming up properly before exercise
  • Long-term steroid therapy
  • Using quinolone antibiotics (e.g., Levaquin or Cipro)
  • Prior long-standing tendon disease that weakens the tendon over time
  • High uric acid levels resulting in a condition called gout
  • Rheumatoid arthritis
  • Diabetes mellitus
  • Long-term dialysis and kidney transplantation

How to know that you have torn your Achilles tendon?

With acute ruptures, you’re likely to experience:

  • A sharp pain
  • An audible “pop” or a “snap” at the site of injury
  • A feeling of being kicked or shot in the heel
  • Swelling and bruising around the ruptured tendon
  • Inability to stand, walk, or bear weight on the affected side

What are the treatment options for a torn Achilles tendon?

Both medical and surgical methods are available for the treatment of a torn Achilles tendon. However, which of the two therapeutic options are more appropriate for this injury is still a subject of ongoing debate. In cases of delayed diagnosis, conservative management is unlikely to succeed; hence, surgical repair is recommended. Studies show good functional outcomes and patient satisfaction with both operative and nonsurgical modalities.

Non-surgical measures

Medical therapy for an acutely ruptured Achilles tendon entails:

  • Rest
  • Icing
  • Elevation
  • Pain control
  • Splinting or a boot to immobilize the torn tendon
  • Rehabilitation to maximize function

Surgical treatment

There are two modes of surgical therapies for repairing a ruptured Achilles tendon:

  • Open surgery: The surgeon makes a larger (10 cm or 4 inches) incision on the back of your leg and stitches the torn parts of the Achilles tendon back together.
  • Percutaneous surgery: This is a minimally invasive procedure in which your surgeon makes several small cuts to suture or sew the torn parts of the Achilles tendon back together. Patients who undergo this type of repair have a lower risk of infection but a higher risk of nerve entrapment if the surgeon fails to locate the nerve accurately during surgery.

Dr. Mark Reed uses a suture technique to repair the Achilles tendon. Four sutures are used to pull the tendon back together and to reinforce the tendon strength. While suturing, Dr. Reed takes specific steps to re-establish the length of the tendon appropriately to maximize strength transfer and explosiveness after recovery.

What to expect after surgery?

After surgery, the operated ankle is immobilized in a splint. Once healing begins, your surgeon will recommend physical therapy. According to Dr. Reed, the Achilles tendon is very slow to heal due to its relatively poor blood supply; thus, it can take several months before you can have a complete return to activity.