Achilles Tendon Rupture Injuries


Robert Brophy, MD
Sports Medicine and Shoulder Fellow, Hospital for Special Surgery

Introduction

The Achilles tendon is found on the back of the leg, just above the heel. It attaches the muscles on the back of the leg (the gastrocnemius and soleus) that run from the knee to the heel bone (the calcaneus).

This tendon transmits forces from the muscles to the foot, enabling the foot to push off against the ground when walking, running, or jumping. Obviously, the tendon is very important, not only for athletic activity but also for walking and getting around during normal daily activities.

Causes

While the tendon is very strong, it has a small but real risk for failure. Certain medical conditions and some medicines are known to be associated with an increased risk of rupture. Rupture usually occurs during high stress activities such as running, cutting or jumping, but sometimes the tendon becomes chronically weakened and can give way during simple activities such as walking.

Treatment

The Achilles tendon is vulnerable to rupture and poor healing because the blood supply to the area of rupture is very limited. If a completely ruptured Achilles tendon is not treated properly, it may not heal or heal with scar tissue in an elongated position, and the person will not regain enough strength in the leg for normal daily activities such as walking, let alone running or other athletic activities. The two main treatment options are casting or surgery.

Casting

The goal of casting is to hold the foot and ankle in a position to bring the torn ends of the tendon in proximity, allowing the tendon to slowly heal over time without using invasive surgical techniques. Usually, casting or bracing for up to 12 weeks or more is necessary, but by avoiding surgery, the risks of skin breakdown or infection are reduced. However, the tendon rarely regains full strength or endurance and there is an increased risk of re-rupture when compared to operative treatment.

Surgery

Surgery for Achilles tendon ruptures tends to allow for quicker healing and typically results in a much stronger tendon than casting, although it often remains slightly weaker than the other leg. The concern with surgery is the risk for skin breakdown and infection, which can occur due to swelling and the relatively poor blood supply in the area of the surgery.

High performance athletes with a torn Achilles tendon are almost always treated with surgery to provide a stronger tendon that is less likely to re-rupture. The recovery period is long and requires diligent rehabilitation to restore foot and ankle motion and tendon strength.

Conclusion

Achilles tendon ruptures are most often caused by sudden, strenuous athletic activity, but can also occur as a result of gradual wear. As soon as a rupture is diagnosed, it should be treated to prevent loss of strength and improper healing.

For patients who do not engage in athletics, the decision on how to treat these injuries is made on an individual basis. Generally, more active individuals are likely to benefit from surgical intervention while less active persons may be satisfied with non-surgical treatment of an Achilles tendon injury.


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