The Achilles tendon is situated above the heel and forms the lower part of the calf muscles. It is a continuation of the two calf muscles, the gastrocnemius and soleus muscles, and it attaches to the heel bone. It is the strongest tendon in the human body and must withstand great forces. Its function is to transmit the force produced by the calf muscles to lift the heel and produce the push off during walking, running and jumping. The Achilles can produce force of up to seven times body weight. This shows just how much force it has to withstand during sporting activities, such as sprinting, jumping and turning.
Causes of and contributors to Achilles tendon rupture include trauma (caused by injury, usually an acceleration injury such as pushing off or jumping up). Preceding tendon problems. Chronic Achilles tendonitis (can lead to small tears within the tendon, increasingly weakening it). Certain drug therapies/treatments. Drugs that have been linked to Achilles tendon rupture include. Fluoroquinolone antibiotics - after nearly 900 reports of tendon ruptures, tendonitis and other tendon disorders (most associated with the Achilles tendon) linked to Ciprofloxacin (Cipro) alone were collected in the U.S. Food and Drug Administration (FDA)?s database, at least one public-interest group petitioned the FDA to recommend that a "Black Box Warning" be added to Cipro's packaging. Some researchers speculate this class of antibiotics is toxic to tendon fibers, and that in some cases may reduce their blood supply. Patients should at least be more aware of the potential for ruptures so that they can be switched to other antibiotics at the onset of early warning signals such as tendon pain.
It is important to know that pain at the back of the heel is not always due to Achilles tendon rupture. It may be due to bursitis (fluid accumulation in the heel due to repeated irritation) and tendonitis (pain along the Achilles tendon due to constant friction and irritation). The above disorders tend to improve with use of pain medications and rest, whereas Achilles tendon rupture requires surgery and/or a cast.
If an Achilles tendon rupture is suspected, it is important to consult a doctor straight away so that an accurate diagnosis can be made and appropriate treatment recommended. Until a doctor can be consulted it is important to let the foot hang down with the toes pointed to the ground. This prevents the ends of the ruptured tendon pulling any farther apart. The doctor will take a full medical history, including any previous Achilles tendon injuries and what activity was being undertaken at the time the present injury occurred. The doctor will also conduct a physical examination and will check for swelling, tenderness and range of movement in the lower leg and foot. A noticeable gap may be able to be felt in the tendon at the site of the rupture. This is most obvious just after the rupture has occurred and swelling will eventually make this gap difficult to feel. One test commonly used to confirm an Achilles tendon rupture is the Thomson test. For this test the patient lies face down on an examination table. The doctor then squeezes the calf muscles; an action that would normally cause the foot to point like a ballerina (plantar flexion). When a partial rupture has occurred the foot's ability to point may be decreased. When a complete rupture has occurred, the foot may not point at all. Ultrasound scanning of the Achilles tendon may also be recommended in order to assist with the diagnosis.
Non Surgical Treatment
Pain medicines can help decrease pain and swelling. A cast may be needed for 2 months or more. Your foot will be positioned in the cast with your toes pointing slightly down. Your caregiver will change your cast and your foot position several times while the tendon heals. Do not move or put weight on your foot until your caregiver tells you it is okay. A leg brace or splint may be needed to help keep your foot from moving while your tendon heals. Heel lifts are wedges put into your shoe or cast. Heel lifts help decrease pressure and keep your foot in the best position for your tendon to heal. Surgery may be needed if other treatments do not work. The edges of your tendon may need to be stitched back together. You may need a graft to patch the tear. A graft is a piece of another tendon or artificial material.
An Achilles tendon rupture is a complete tear of the fibrous tissue that connects the heel to the calf muscle. This is often caused by a sudden movement that overextends the tendon and usually occurs while running or playing sports such as basketball or racquetball. Achilles tendon rupture can affect anyone, but occurs most often in middle-aged men.