A total tear in the Achilles tendon can happen in any part of its length. It is a sudden, traumatic injury. When the tendon snaps, it leaves two broken ends which may stay close together or spring apart, leaving a visible dent. There may also be bruising.
Rupture is very rare in children, uncommon in teenagers, and happens most often to people in early and later middle age.
What you Feel When you Have Achilles Tendon Rupture
You feel as if something has hit you hard in the back of the leg. If you try to walk, you stumble or fall over. Your foot feel floppy: you can draw the foot upwards into dorsiflexion, but while toes can still move downwards into flexion, you cannot point the foot down at the ankle. If you lie on your stomach, the foot falls to a right angle. If the gastrocnemius muscle is squeezed, the foot does not move as it normally would: this is a standard test for Achilles tendon rupture, and does not cause pain.
Causes for Achilles Tendon Rupture
Although the rupture can be caused by a direct blow to the back of the leg when the calf is under tension, more often it is intrinsic, with no obvious cause. It usually happens late in an exercise session or competition, and is associated with fatigue and circulatory problems rather than being cold or not warmed up properly. You may have had previous warning signs, such as tightness, cramping or involuntary twitching in the calf. You may have been stressed, overtired or suffering from an infection. The tendon may have been weakened by previous injury or injection, or overworked by compensating for a previous thigh or foot injury.
Treatment for Achilles Tendon Rupture
The foot must be supported immediately with bandaging or taping in the plantarflexed position, pointing down from the ankle. Avoid putting weight through it: hop using crutches. If you have to put the foot down, keep the leg away from your body turned out sideways, and try to keep your weight on the heel.
Seek specialist advice as quickly as possible. You have the choice of an operation or non-intervention. Surgery can be done through a scar as open surgery.
Non-intervention is a choice between either immobilisation in a plaster cast for several weeks, or support in a removable walking boot which allows weight-bearing, remedial therapies, exercises and alternative training to commence immediately. You should decide with your doctor which approach you want to use, and then follow all instructions to the letter.
Read more about Achilles Tendon Injury: Should I go for Surgery?.
Rehabilitation Phases
In all cases the foot is held pointing downwards in plantarflexion for the first phase, as the tendon has to be prevented from lengthening as it heals. If it is not in plaster, the leg can be taped to hold the position. Crutches are used as directed by the specialist. In the case of the walking boot they may not be needed for long, but should be used when exercises are done without boot on.
Rehabilitation starts with calf strengthening holding the Achilles tendon in a shortened position. Progression through the rehabilitation phases should generally be pain-free. However, sometimes following open surgery there is a moment when some movement causes a tearing sensation around the scar, almost as if the injury has happened again. This is usually due to adhesions round the scar breaking, and does not interfere with your progress to fitness. If in doubt, refer back to your doctor.
Achilles Tendon Specialist
DR KEVIN YIP
