Achilles Tendon Rupture

Tendons are the fibrous connective tissues that connect muscles to bone in the human body. A key feature of all tendons is their capacity to withstand significant forces; the Achilles tendon is the largest tendon in the body, extending from the gastrocnemius (calf muscle) to the calcaneus (heel bone). The Achilles tendon is essential to effective and graceful human movement, an integral component to all walking, running, and jumping actions that the body performs. The Achilles tendon is engaged every time the calf muscle contracts to propel the body forward, through the process known as plantar flexion.

The mythical Greek warrior Achilles was said to be invincible, until an arrow pierced the lower leg tendon that bears his name. An injury to the modern Achilles tendon may not be fatal, but there is no question that a rupture of this critical structure can have devastating consequences on athletic performance.

The Achilles tendon is liable to sustain injuries for which the consequences range from mild impairment of its function to a total disabling. Achilles tendonitis is a condition in which the tendon fibers become inflamed by friction between the tendon and its covering cellular sheath, usually through either overexertion or a lack of flexibility in the tendon and calf muscle. An Achilles tendon tear is partial separation or detachment of the fibers, caused when the tendon is overstretched. A rupture describes the condition in which either the tendon is completely torn or has become entirely detached from the heel bone.

When a rupture of the Achilles tendon occurs, the athlete will not be able to move very efficiently, as the lower leg structure is now disconnected and unstable. It is impossible to walk or run normally with a ruptured Achilles tendon. A tendon rupture will often occur without warning, as the victim will often experience a sudden pop or similar stabbing sensation in the lower leg, indicating the damage to the tendon has occurred.

A ruptured Achilles tendon can occur in a variety of athletic activities. As the rupture often occurs in persons who do not stretch properly prior to their athletic participation, the "weekend warrior," the prototypical male athlete between the ages of 30 and 50 years who is interested in recreational sports participation, but not necessarily injury prevention, is a common Achilles casualty.

The leading causes of Achilles tendon rupture include: overuse or overtraining; excessive hill running; running on hard surface such as pavement or earlier generations of artificial turf; a direct trauma to the tendon; poor or nonexistent stretching regimes; tight calf muscles; poor quality or worn out athletic shoes; and structural deficiencies such as flat-footedness.

A ruptured Achilles tendon will swell noticeably soon after the injury has occurred, with bruising usually visible. Immediate first aid should be the application of ice, to reduce swelling, and moderate pressure to the injury with a compression bandage. Such an injury will require further medical attention, as a failure to treat this serious injury may result in an improper mending of the tendon fibers, and a corresponding crippling of the leg function. To determine whether the Achilles is ruptured, a physician will often employ what is known as the Thompson test. This test involves a seating of the patient in a chair, permitting the foot on the leg suspected as damaged to dangle towards the floor. If upon a squeeze of the calf muscle the toes of the foot do not point toward the floor, the tendon is considered ruptured.

The repair of the damaged tendon will involve one of two procedures. With surgery, the ruptured pieces of the tendon will be reattached to the heel bone from which it became detached. Upon the completion of surgery, the patient will wear a cast to keep the lower leg stable, for between 6 to 12 weeks. However, if there are inherent risks in surgery, such as an unrelated physical condition, the patient's foot will be placed in a cast. There is a greater risk of rerupture when this procedure is employed.

A common fear regarding the resumption of training with the rehabilitated Achilles tendon is a loss of flexibility in the tendon. In sports such as basketball and soccer, which place a premium on lateral quickness and explosive movement, extreme care must be taken in the tendon rehabilitation process. The athlete must take care to gradually return to the level of play obtained prior to the tendon injury.

Rehabilitation should be undertaken with the following considerations:

1. Assess the quality and construction of the athletic shoes to be worn. To reduce the risk of a recurrence of the tendon rupture, the shoe should be well cushioned in the heel to lessen the forces of the heel strike on impact. Where the alignment of the lower leg is believed to be a factor in the cause of the rupture, an orthotic should be considered.
2. A thorough warm up, with attention paid to the stretching of the entire lower leg structure, is of critical importance.
3. There should be a very gradual increase in both training intensity and duration in the rehabilitative process; such increases should not exceed 5% to 7% per week.
4. Hard running, such as hill running or sprinting, should be avoided in this phase.

SEE ALSO Achilles tendonitis; Ankle anatomy and physiology; Lower leg anatomy; Lower leg injuries; Skeletal muscle; Tendinitis and ruptured tendons.