An Achilles tendon rupture is also known as a rupture of the gastrocnemius tendon, or the common calcanean tendon. The tendon is actually composed of 5 different tendons, the two most important being the superficial digital flexor and gastrocnemius tendons. The gastrocnemius tendon is the largest of these, and is the most powerful extensor of the hock (ankle) joint. Both the superficial digital flexor and gastrocnemius tendons attach to the heel bone, called the calcaneus bone. A rupture of the Achilles tendon may be a partial tear, which means just the gastrocnemius is torn, or a complete tear, in which all five tendons have been torn. (show diagrams, normal anatomy vs partial vs complete tears).
The tendon usually ruptures without any warning. It is most common in men between the ages of 40-50, who play sports intermittently, such as badminton and squash. There was probably some degeneration in the tendon before the rupture which may or may not have been causing symptoms.
An Achilles tendon rupture is when the tendon that connects the heel bone to the calf muscle tears and the fibers separate. This happens mostly between the ages of 30 and 50, and usually is caused by sports. Symptoms of Achilles tendon rupture include the following. A pop or snap when the tendon tears. Severe pain in back of the ankle, making it nearly impossible to walk. Swelling and discoloration. Tenderness. Inability to rise on toes. A gap in the back of the ankle where the tendons are separated.
Diagnosis is made mostly by clinical examination with a defect usually noted on visual examination and by touching the area. A simple test can be done by squeezing the back of the calf with the foot resting in the air. Normally when squeezing the muscle belly the tendon will shorten causing the foot to move in a downward position. With a rupture this squeezing effect may show no movement of the foot if it is not attached properly. A negative test does not mean there isn't some degree of rupture as some of the tendon fibers may still be attached. Sometimes x-rays, an mri, or an ultrasound can be helpful in determining the extent of the rupture.
Non Surgical Treatment
Your doctor may advise you to rest your leg and keep the tendon immobile in a plaster cast while it heals. Or you may need to have an operation to treat an Achilles tendon rupture. The treatment you have will depend on your individual circumstances, such as your age, general health and how active you are. It will also depend on whether you have partially or completely torn your tendon. If you have a partial tear, it might get better without any treatment. Ask your doctor for advice on the best treatment for you. If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.
Debate remains regarding the best form of treatment for a ruptured Achilles tendon. The 2 options are:immobilisation or operation. A recent meta-analysis of scientific studies showed that compared to immobilisation, an operation reduces the risk of re-rupture and allows a quicker return to work. An operation is not without risk and these must be balanced against the benefit of a lower re-rupture rate. Both treatments involve immobilisation for 8 weeks.
The best treatment of Achilles tendonitis is prevention. Stretching the Achilles tendon before exercise, even at the start of the day, will help to maintain ankle flexibility. Problems with foot mechanics can also lead to Achilles tendonitis. This can often be treated with devices inserted into the shoes such as heel cups, arch supports, and custom orthotics.