Achilles Tendon (Calcaneal Tendon) Rupture

What are the symptoms of a ruptured or torn Achilles?

Sudden, sharp pain in the back of the ankle is usually experienced with an acute Achilles tendon rupture. Patients may even feel a “pop” of the tendon and some report that it “felt like a shot” or that they thought that someone “kicked the back of their leg.” 

Patients relate that the pain does not last very long and — although there is swelling on the bag of the leg — the pain often subsides. Some patients may not realize they have an Achilles tendon tear for a while, resulting in a chronic tear that may require additional care beyond a primary Achilles repair surgery.

Some patients come in complaining they “sprained their ankle,” but under examination, we find weakness to plantar flexion and a palpable gap in the tendon.

What are risk factors for an Achilles tendon rupture? 

Most acute ruptured tendons I see in my practice are from “weekend warriors” who are between their early 20s and late 60s and engage in frequent physical activity. 

Factors that may increase your risk of Achilles tendon rupture include:

• Sex. Men are up to five times more likely to experience an Achilles tendon rupture than women.
• Recreational sports. Achilles tendon injuries are more frequently observed in sports that involve activities like running, jumping, and sudden changes in movement, such as soccer, basketball, and tennis.
• Steroid injections. Some physicians may administer steroid injections into the ankle joint to alleviate pain and inflammation. However, it's important to note that this treatment can potentially weaken nearby tendons and has been linked to an increased risk of Achilles tendon ruptures.
• Certain antibiotics. Research shows that fluoroquinolone antibiotics, such as Ciprofloxacin (Cipro) or Levofloxacin (Levaquin), have been associated with an elevated risk of Achilles tendon rupture.
• Obesity. Excessive body weight places additional strain on the Achilles tendon, making it more susceptible to injury.
• Medical conditions. Certain systemic diseases, such as rheumatoid arthritis and diabetes, can affect the health of the tendons, including the Achilles tendon.
• Pre-existing Achilles tendinopathy. If your Achilles tendon is already injured or under strain, it is more prone to a tear or rupture.
• “Weekend warriors.” Adults who don't train regularly and then exercise at a high intensity are suddenly at risk of Achilles tendon injuries or tears.

After experiencing an Achilles tendon tear, there is a 6% chance of sustaining the same injury in the opposite foot.

How is a torn Achilles tendon diagnosed?

During the physical exam, University Foot and Ankle Institute’s healthcare team will look for swelling, bruising, and possible defects near the rupture region. Our doctor will also test the functionality of the calf muscle as well as your level of plantar flexion (ankle flexing).

Our doctors may also perform the Thompson Test by squeezing the calf muscle. If the foot does not move downward with this squeeze, the Achilles is not attached to the muscle and indicates a ruptured tendon.

While we can usually assess and diagnose a tear with a simple examination, we often turn to imaging to confirm the diagnosis. Magnetic resonance imaging (MRI) is a mainstay of imaging, but we have begun to use in-office ultrasound for my testing and radiographic diagnostics. Ultrasound testing is inexpensive, fast, and easy to perform, as well as dynamic. An ultrasound can show if the tendon ends approximate plantarflexion, which is helpful in planning the treatment course.

What are treatments for torn Achilles tendon?

Treatments for an Achilles tendon tear can be categorized into non-surgical and surgical options. Non-surgical methods typically include rest, ice, compression, and elevation (RICE), along with physical therapy and sometimes immobilization in a cast or brace to allow the tendon to heal naturally. 

On the other hand, surgical intervention may be recommended to repair the tendon, particularly in cases where complete rupture has occurred or in active individuals who may demand quicker recovery times and diminished risk of re-injury.

Partially torn Achilles treatment

The treatment for a rupture of the Achilles tendon is determined by the severity of the tear. Nonsurgical treatments may be an option if the Achilles is only partially torn.

These nonoperative treatments include a walking boot or cast immobilizing the tendon while it heals. It is important to note that conservative treatments are associated with a high rate of re-injury, or re-rupture, of the Achilles.

Surgical repair of a partially torn Achilles tendon can be performed, but the exact treatment we choose will depend on the extent of your injury. An acute, partially torn Achilles can be repaired by sewing the torn area back together. If the partial tear is chronic and the tendon has an abundance of scar tissue, this scar tissue may need to be surgically removed.

Occasionally, a graft can be wrapped around the tendon’s defect to help augment the repair. This is done as outpatient surgery and includes many benefits over conservative options, including a reduced re-rupture rate, improved muscle function of the ankle, and quick return to pre-injury activity levels.

Patients generally wear a cast for three weeks to immobilize the Achilles while it heals. Once the cast is off, we’ll refer you to physical therapy to strengthen the tendon and improve your range of motion.

Ruptured Achilles tendon treatment

If an Achilles is completely ruptured, surgery is generally required to reattach the tendon. Surgical methods could provide stronger tendon repair and potentially lower the chance of a future tear

It’s rare for us to consider nonsurgical Achilles casting as an option for acute rupture of the Achilles tendon, but it is sometimes worth considering. Depending on what the ultrasound shows, we may have success casting the ankle in a plantarflexed position. However, nonsurgical treatment does come with higher rate of re-rupture and longer recovery time. Casting can also result in a tendon that is weak or not at optimal length.

What is the PARS Procedure?

At the University Foot and Ankle Institute, we utilize the percutaneous Achilles repair system (or PARS) minimally invasive technique. This surgical technique offers a faster and more aesthetically pleasing recovery than traditional methods.

The benefits of the minimally invasive PARS surgical technique allow for a very small incision, much less scarring, and a cleaner, speedier recovery. Our recovery process has resulted in weight-bearing and physical therapy, often at four weeks, and a return to sports activity at about three months. Read more about the PARS procedure here.

If the tear is distal or there isn’t enough quality tendon to do a direct repair, we can anchor the sutures to the heel bone. While this technique is more difficult, the repair is stronger.

Achilles tendon repair surgery recovery

After torn Achilles surgery, you will be in a cast for five weeks to allow the tendon to heal. At five weeks, you will be placed in a tall boot with one inch of lift — at this point, you’ll be cleared for weight-bearing and will start physical therapy to recover your range of motion. Over three weeks, portions of the lift will slowly be removed during follow-up appointments. At ten weeks post-surgery, protection can be removed and therapy continues.

Full recovery may take three to six months total. During this time, prescription or over-the-counter pain medicine may be used to manage any pain.

What happens with untreated Achilles tendon ruptures? 

If a ruptured Achilles tendon has been neglected or misdiagnosed, the muscle will retract, and a simple end-to-end repair of the torn tendon is often no longer possible. In these cases, the calf muscle can be lengthened to reattach the two ends, or a tendon transfer can be performed to reconstruct the Achilles tendon.

In cases where a tendon transfer is needed, the flexor tendon to the big toe is harvested and attached to the heel bone to function as the Achilles tendon. Recovery from this procedure is usually similar to acute tendon tear repair and extensive therapy will be needed to strengthen the area.

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Achilles Rupture Patient Review, in his own words...

The following five-star Yelp review was posted by University Foot and Ankle patient, Mark:

Unquestionably The Best!

 

I am a 62-year-old mountain climber and I ruptured my Achilles tendon. Due to my insurance, treatment was delayed for almost a year. Most of the doctors I visited were very negative about my prognosis. Dr. Baravarian was not.

 

My Achilles was a complete write off so he had to perform a flexor tendon transfer. The end result couldn't have been better. Against all odds, I was walking in 2 months and back climbing in 4. I experienced ZERO pain or negative after-effects.

 

His staff and associated PT group are a first-rate team. Dr. Baravarian provided honest, direct, and lucid explanations about the procedure and cooperated with my accelerated rehabilitation process (despite his reservations). Had I been a professional athlete I wouldn't have received better care. It is impossible to rate Dr. Baravarian and his team high enough.

 

Read Mark's review on Yelp here.

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Why UFAI is the Best Choice for Achilles Tendon Injuries

The physicians and surgeons at University Foot and Ankle Institute are nationally recognized leaders in the treatment of Achilles tendon injuries. They have worked closely in the development of new minimally invasive surgical techniques, including the PARS technique. The PARS technique is a minimally invasive state-of-the-art technology that results in higher success rates, less scarring, and a quicker, stronger recovery.

While our Achilles tendon specialists always opt for the most conservative treatment, you can be assured that you are being truly cared for by University Foot and Ankle Institute you have decades of experience and state-of-the-art techniques in your corner.

To schedule a consultation, please call (855) 872-5249 or make an appointment now.

University Foot and Ankle Institute is conveniently located throughout Southern California and the Los Angeles area. Our foot doctors are available at locations in or near Santa Monica, Beverly Hills, West Los Angeles, Manhattan Beach, Northridge, Downtown Los Angeles, Westlake Village, Santa Barbara, and Valencia.

 

 

Ruptured Achilles FAQs

 

How can you prevent Achilles tendon injuries?

While you can't always foresee accidental injuries like Achilles tendon tears, there are proactive measures you can adopt to lower the risk of an Achilles tendon rupture, which include:

• Warm-up routine: Before engaging in any workout or sports activity, it's essential to perform warm-up exercises. These activities help prepare your muscles and tendons for the demands of physical exertion.
• Gradual intensity increase: Gradually increasing the intensity of your workouts and activities is crucial. This allows your body to adapt and become better equipped to handle the stress placed on your Achilles tendon.
• Regular stretching: Incorporate regular stretching into your routine, focusing on your calf muscles and Achilles tendons. Stretching helps maintain flexibility and can reduce the risk of injury.
• Avoid smoking. Smoking negatively affects tendon health and should be avoided as it increases the risk of tendon injuries, including Achilles tendon tears.

 

 

Can Achilles tendinitis or tendinosis contribute to a rupture?

Yes. Achilles tendinitis is commonly an overuse condition characterized by inflammation and irritation of the Achilles tendon, which is the large tendon at the back of the leg that connects your calf muscles (gastrocnemius) to your heel bone (calcaneus). When the tendon is inflamed, it becomes weaker and more susceptible to injury, including a rupture.

 

What is insertional Achilles tendonitis?

Unlike non-insertional Achilles tendonitis, which affects the middle portion of the tendon, insertional Achilles tendonitis occurs at the lower end of the tendon, near the heel bone.

 

How should one manage the symptoms of an Achilles tendon rupture before seeking medical attention?

If you suspect an Achilles tendon rupture, it's crucial to take immediate steps to manage the symptoms before seeking medical attention. Here's what you can do:

• Rest: Avoid putting weight on the affected leg. Resting the tendon can prevent further damage.
• Ice: Apply ice to the injured area to reduce swelling and alleviate pain. Use a cloth or towel to protect your skin, and apply the ice for 15-20 minutes every one to two hours during the first 48 hours.
• Compression: Wrapping the injured leg with an elastic bandage or compression sleeve can help control swelling. Be careful not to wrap it too tightly, as it may impede blood circulation.
• Elevation: Elevate your leg above the level of your heart when resting.
• Pain medication: Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage pain and inflammation.

 

Sources 

Achilles tendon rupture. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=av0003. Accessed June 26, 2017.

Author links open overlay panelSharrona Williams. “Ankle Tendon Disorders and Ruptures.” Clinical Sports Medicine, Mosby, 15 May 2009, www.sciencedirect.com/science/article/abs/pii/B9780323025881500725