Achilles Tendon Rupture

What is an Achilles tendon rupture?

• Your Achilles tendon has ruptured if it gets a tear in it. A tendon is body tissue that connects your muscles to your bones. Your Achilles tendon connects the calf muscle in your lower leg to your heel bone. It is the strongest tendon in your body. Your Achilles tendon acts like a spring by taking the force (pressure) from your body when it moves. Your Achilles tendon also allows you to point your foot downward and rise on your toes. This allows you to push your foot toward the ground, such as when walking, running, or jumping.
  
  
• A rupture can be a partial (incomplete) or a complete tear. A rupture can be acute (sudden) or chronic (lasting) if you do not get treatment right away. A rupture often occurs just above your heel bone in one or both of your legs. However, you may get a rupture anywhere on your Achilles tendon. Having your rupture treated may help increase the strength in your leg muscles. Treatment may help decrease your pain. You may be able to return to work sooner and do your normal daily activities more easily after treatment.

What causes an Achilles tendon rupture?

Your Achilles tendon can rupture if too much pressure is put on it. This may happen when playing sports or during a fall down stairs or off of a ladder. Your Achilles tendon may rupture when it is directly injured, such as when hit or kicked.

What conditions may increase my risk of having an Achilles tendon rupture?

The following conditions may make your Achilles tendon weaker and more likely to tear:

• Bone structure: You may have abnormal bone structure in your foot.
  
  
• Previous rupture: Your Achilles tendon may have been ruptured before.
  
  
• Inflammation: Your tendon may have inflammation (swelling).
  
  
• Being overweight: Weighing more than your caregiver suggests may put too much stress on your Achilles tendon.
  
  
• Medical conditions: You may have medical conditions that affect your tendons. Rheumatoid arthritis is a disease of your joints that causes inflammation and new bone growth. Your joints are where two bones meet, like at your ankle. Other medical conditions that could affect tendons include diabetes (high blood sugar) and kidney problems. Your kidneys are bean-shaped organs that turn chemicals and waste from your blood into urine. Ask your caregiver for more information about these conditions.

What else may increase my risk of having an Achilles tendon rupture?

• Activity: If you are not usually physically active, your Achilles tendon may be weak. If you become active but have a weak Achilles tendon, it may rupture. This often happens when people start playing sports after not being physically active for a long time.
  
  
• Age: As you get older, your Achilles tendon may become stiffer and less flexible. This may make your tendon more likely to rupture.
  
  
• Medicines: Certain medicines may make your Achilles tendon weak and more likely to rupture. You may have taken steroids to help your muscles grow or decrease swelling. Taking antibiotics may weaken your Achilles tendon. Antibiotics are medicines used to fight infections caused by germs called bacteria.

What are the signs and symptoms of an Achilles tendon rupture?

You may have any of the following:

• A sudden pop, snap, or crack at the back of your leg or heel.
  
  
• Severe pain in your leg or the back of your ankle.
  
  
• Swelling, stiffness, or weakness in your leg or foot.
  
  
• A bruise on the back of your leg or foot.
  
  
• Fallen forward while you walk.
  
  
• Trouble balancing or putting weight on your leg.
  
  
• Trouble going up and down stairs.
  
  
• Trouble moving your leg or foot.

How is an Achilles tendon rupture diagnosed?

Your caregiver will ask you about your symptoms and your recent physical activities. He will also ask what you were doing at the time of your injury. Tell your caregiver about your past medical conditions and what medicines you take. Your caregiver will look at your ankle area and the back of your leg very closely. He may look or feel for a gap on the back of your leg near your ankle. He also may do any of the following:

• Calf-squeeze test: Your caregiver will ask you to lie on your stomach on a table or bed. Your feet will hang over the edge. Your caregiver will squeeze the lower part of your calves. Your caregiver may then repeat the test on your other leg to compare them to each other. If your foot does not move when your calf is squeezed, you may have a ruptured Achilles tendon.
  
  
• Heel raise test: This is also called a tiptoe test. You may be asked to stand on your toes so your heels are raised off the ground. If this is hard for you to do, you may have a ruptured Achilles tendon.
  
  
• Knee flexion test: Your caregiver will ask you to lie on your stomach on a table or bed. You will be asked to bend your knees until your lower leg is straight up. If your injured foot points downward during the test, your Achilles tendon may have a rupture.
  
  
• Needle test: Your caregiver will insert a needle a few inches above your heel into the skin of your calf. Your caregiver will then move your foot in a downward and then upward direction. While doing this, your caregiver will see if the needle moves while your foot is pointing upward. You may have an Achilles tendon rupture if the needle does not move or points downwards.
  
  
• Sphygmomanometer test: A sphygmomanometer is the cuff put around your arm when your caregiver takes your blood pressure. During this test, you will be asked to lie on your stomach on a table or bed. The cuff will be wrapped around the middle of your calf. The cuff is filled with air and then your caregiver moves your foot towards your body. If the pressure in your calf does not increase, then you may have an Achilles tendon rupture.
  
  
• Imaging tests: Your caregiver may use imaging tests to help confirm whether your have torn your Achilles tendon. He also may use these tests to help him check for other problems that may be causing your symptoms.
  
  
  • X-ray: Your caregiver may take x-ray pictures of your ankle and foot. The pictures may help your caregiver see if there is swelling in your tendons or muscles, of if you have broken any bones. An x-ray also may show changes in the shape of the tendon and surrounding spaces.
    
    
  • Magnetic resonance imaging: This is also called an MRI. During an MRI, pictures are taken of your Achilles tendon and the muscles and bones around it. Your caregiver will use this image to see how much tendon damage you have. This image also may show if you have swelling and bleeding around the torn tendon. You will need to lie still during an MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. Metal objects can cause serious injury.
    
    
  • Ultrasound: An ultrasound is a simple test that looks at the inside of your body. Sound waves are used to show pictures of your Achilles tendon on a TV-like screen. This may help your caregiver see if your Achilles tendon is torn.

How is an Achilles tendon rupture treated?

Your treatment will depend on your health, age, level of activity, and type of rupture. You and your caregiver will decide on the treatment that is best for you.

• Casts: Your caregiver may put a cast on your leg. This cast may stay on your leg for two months or more. The cast may go up to your knee or may extend past your knee. Your foot will be positioned in the cast with your toes pointing slightly downwards. Your caregiver will change your cast and your foot position several times during the time you are healing. You will not be able to move your foot and ankle until your Achilles tendon heals. Do not move or put weight on your foot until your caregiver tells you it is okay.
  
  
• Leg braces: You may be asked to wear a leg brace or splint to prevent you from moving your foot. These braces will allow you to move your leg and walk when your caregiver says it is okay. Leg braces also may help prevent you from getting another injury in your leg, ankle, or foot.
  
  
• Heel lifts: Heel lifts are special wedges that are put into your shoe or cast. Heel lifts help keep your foot in the best position for healing.
  
  
• Surgery:
  
  
  • Open surgery: Your caregiver will make a cut on the back of your leg next to your ruptured Achilles tendon. The edges of your Achilles tendon will be sewn back together with special thread (sutures). If your tear is very wide, your caregiver may use pieces of another tendon or man-made material. These pieces are called grafts and are used to patch the tear in your Achilles tendon. Your caregiver will then close the cut with stitches and put your leg in a cast.
    
    
  • Percutaneous surgery: Your caregiver will make several small cuts on the skin near your ruptured Achilles tendon. Your caregiver will then use special tools to sew your Achilles tendon. Your caregiver will then close the small cuts with stitches and put your leg in a cast.

What are the risks of having my Achilles tendon rupture treated?

• With or without treatment, your Achilles tendon may rupture again. If your Achilles tendon ruptures, you may get an infection or a tear in your skin. If you have surgery, you may develop keloids (big scars), skin problems, or numbness in your ankle or foot. After surgery, a blood clot may form in the veins of your leg and may cause a pulmonary embolism (PE). A PE is when a blood clot blocks an artery (blood vessel) in your lungs. A blood clot may cause a heart attack or a stroke, and you may die.
  
  
• Without treatment, you may always have trouble walking or moving your foot. One or more of your bones may break. The nerves in your leg may be injured. This may cause a numbness, tingling, or burning feeling in your leg. If the blood clot causes a PE, heart attack, or stroke, you may die. Ask your caregiver for more information about your ruptured Achilles tendon, treatment, or care.

When should I call my caregiver?

Call your caregiver if:

• You have swelling in your ankle, heel, or leg.
  
  
• You have pain in your ankle or heel area.
  
  
• The muscles in your legs become weak.
  
  
• You have a fever (high body temperature).
  
  
• The skin on any part of your legs or hips turns purplish in color.
  
  
• You have questions or concerns about your condition, treatment, or care.

When should I seek immediate care?

Seek care immediately or call 911 if:

• You feel a sudden pop, snap, or crack at the back of your leg or heel.
  
  
• You have trouble standing up or walking.
  
  
• You cannot move your leg or foot.
  
  
• You feel like you may have broken a bone.
  
  
• You have trouble breathing.
  
  
• You have convulsions (seizures) or migraines (very bad headaches).
  
  
• You have chest pain.

Where can I find support and more information?

Contact the following:

• American Academy of Orthopaedic Surgeons
  6300 North River Road
  Rosemont , IL 60018-4262
  Phone: 1- 847 - 823-7186
  Web Address: http://www.aaos.org/
  

• American Physical Therapy Association
  1111 North Fairfax Street
  Alexandria , VA 22314
  Phone: 1- 800 - 999-2782
  Web Address: http://www.apta.org
  

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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