Achilles Tendon Rupture

Chris Reed - Agile Physical Therapy

In this issue I would like to discuss a topic that tends to come up over the summer months. With the weather turning warm, many of us are turning to outdoor activities for our exercise. These activities often include a pick-up game of basketball at the park, a run in the hills at Rancho, or a game of volleyball at the beach in Santa Cruz. All of these activities can place the middle-aged athlete at greater risk for an Achilles tendon rupture. In this article we will cover the anatomy and physiology of the Achilles tendon, common mechanisms of injury, treatment, and prevention strategies.

The Achilles tendon is a thick fibrous tendon that attaches the gastrocnemious and soleus muscles in the calf to the calcaneus, or heel bone. This strong ropelike structure is the largest tendon in the human body. When the calf muscle contracts, tension is placed through the Achilles tendon causing it to pull on the calcaneus and move the foot downward, or into dorsiflexion. The Achilles tendon allows us to go up onto our tiptoes, walk, run, and jump normally.

Age and lack of use commonly weaken the Achilles tendon over time. The middle aged male weekend warrior has the greatest likelihood of rupturing an Achilles tendon. Sports that involve running, jumping, pivoting, and sudden quick changes in direction have a greater incidence of Achilles tendon ruptures associated with them. These sports include basketball, tennis, racquetball, and volleyball. The mechanism of injury is generally an overstretching of the tendon while it is being loaded. Other causes include running in the hills, overuse, poor stretching habits, worn out shoes, and flat feet.

Often times people report the feeling of rupturing the Achilles tendon as if someone stepped on their heel or whacked them in the heel with a bat. A loud pop or crack is commonly felt and/or heard at the time of the injury. There is pain and swelling that develops at the back of the ankle. The area of the tear can be palpated as a gap or depression in the tendon and is commonly located about 2 inches above the heel. The athlete will have an inability to push up onto their toes or to push of while walking.

Initial treatment should include rest, ice, compression, and elevation of the injured limb. It is recommended that the athlete who is suspected of suffering from an Achilles rupture see a surgeon as soon as possible. The surgeon will ask several questions about how the injury occurred and perform a couple of tests in the office to make the clinical diagnosis. If a partial tear is suspected, the surgeon may elect to get an MRI of the injured ankle. The surgeon will discuss operative and non-operative options to treating the injury. For the more active and athletic population it is often recommended that the rupture be surgically repaired. This allows for the athlete to get back to their sport sooner, stronger, and with less risk of re-rupturing the repaired tendon than treating the injury non-surgically.

Following surgery, the athlete will spend between 6-12 weeks in a walking boot. At about the 3-4 week mark physical therapy begins. Over the next 3-4 months you will work to regain the mobility in the Achilles tendon, regain your calf strength as well as the strength in the rest of your leg. It will be 6-9 months before you are able to resume your sport activities.

To reduce your risk of developing an Achilles tendon problem, the following steps are recommended. Remember to perform a slow controlled stretch prior to partaking in any activity. Try to cross train using higher impact activities and lower impact activities on alternate days. Don’t exercise through pain. Strengthen your calf muscles by doing 3 sets of 25 heel raises. Start by doing it on both feet together. Eventually, you can move to doing one leg at a time. Remember to ice following exercise.

References:

1. Total Achilles Tendon Rupture. Available from URL: http://www.sportsinjuryclinic.net/
cybertherapist/back/achilles/achillestotal.htm (Accessed June 2007).
2. Achilles Tendon Rupture. Available from URL: http://www.emedicinehealth.com/
achilles_tendon_rupture/article_em.htm (Accessed June 2007).
3. Achilles Tendon Rupture. Available from URL: http://www.mayoclinic.com/health/
achilles-tendon-rupture/DS00160/DSECTION=1 (Accessed June 2007).