Wright State University Sports Medicine Blog


Pop, goes the achilles

achilles As you are running the court on a fast break during your lunch time pick-up basketball game, doing your typical Allen Iverson impersonation, you plant your foot to go strong to the rim, and feel a sharp, stinging pain radiate down the back of your ankle and into your foot. As you call for a foul and roll over expecting to see John from accounting, standing on the court and still swinging the mace that he just hit you with, you are shocked to see that no one is near you. To your dismay, the picture begins to become clearer, you may have been the victim of an achilles tendon rupture.

The achilles is a tendon that connects the gastrocnemius/soleus complex, better known as the calf muscle, to the calcaneus (bone in the heel). If the tendon is overstretched it can completely or partially tear (rupture). Generally with an achilles tendon rupture, a pop and a very sharp pain are felt in the back of the ankle that usually affects the ability to walk. Partial tears (and even complete ruptures) sometimes go misdiagnosed because many people still have the ability to point their toes, or plantar flex. This is due to your plantaris muscle still being intact, and along with your toe extensors, you are able to actively move your foot.

If you experience anything like this, please follow up with an orthopedic physician to make sure you have not injured you achilles. Some common symptoms of achilles tendon rupture are pain and swelling near the heel, a possibility of a popping or snapping sound occurring during the initial injury, the achilles is responsible for plantar flexion; so pushing off when walking or standing on the toes is very difficult if not impossible. The body relies on the Achilles tendon every time the foot needs to move so make sure you are protecting the area. The Mayo Clinic states, “a rupture usually occurs in the section located within 2.5 inches from the point of attachment to the heel (calcaneus)” but they can occur anywhere along the tendon. Ruptures often are caused by sudden increase in stress on the tendon; increasing the intensity of sports participation, falling from a height, or stepping in a hole can cause this stress.

Risk factors that can increase the chance of an achilles rupture include: age, sex, playing recreational sports, steroid injections and certain antibiotics. The peak age for a tendon rupture is between 30 and 40 years old. Men have been shown to be five times more likely to rupture their achilles tendon then women are. Recreational sports that involve running, jumping and sudden start and stops like basketball, tennis, and soccer, increase the chances of achilles rupture. Steroid injections into the ankle joint to reduce pain and inflammation can weaken tendons nearby and have been associated with tendon ruptures. Lastly, certain antibiotics like ciprofloxacin (Cipro) or levofloxacin (Levoquin) increase the chances of an achilles tendon rupture, so please speak with your physician about other options if you are active.

There are two common treatment options for an achilles tendon rupture: surgical and non-surgical intervention. Surgery is a common treatment for complete ruptures of the achilles tendon and it provides the tendon with the best possible chance to heal completely. The procedure requires an incision in the back of the lower leg to stitch the tendon together. If the torn tissue is not able to be sewn together to recreate an autonomous tissue, other tendons may be used for reinforcement. Non-surgical treatments involve wearing a cast or walking boot with wedges to elevate the heel allowing the tendon to heal. The non-surgical method can be just as effective and avoids the risk of infection found with open procedures. Debate continues to rage in the orthopedic world about the best method, but it is really dependent upon you lifestyle and preference. Our advice on surgery is this; if you cannot do what you want to do, in the manner that you want to do it, surgery is probably the best option. However, if you can live the lifestyle you want without surgery, then don’t maybe a more conservative treatment is for you.

Achilles tendon ruptures can be minimized, although prevention is debatable. Some sound methods of minimizing risk include: stretching and strengthening of gastroc/soleus complex (calf muscles), varying the types of exercises you participate in, avoiding running on surfaces that are wet or slippery, and increasing training intensity slowly. If you suspect an achilles tendon rupture, seek medical attention immediately. The longer wait time between evaluation and treatment by a healthcare professional, can cause the tendon to shorten and repair can become more difficult.

The link below is to the Mayo clinic. It has plenty of information about Achilles tendon ruptures and prevention.

http://www.mayoclinic.com/health/achilles-tendon-rupture/DS00160/DSECTION=prevention

The site below gives great information about the Achilles tendon. It also goes back many years in history and talks about the Greek mythology as to why the tendon is named Achilles. There are also interesting pictures that show what a ruptured tendon may look like.

http://www.healingfeet.com/blog/foot-care/dont-be-a-heel-prevent-achilles-tendon-injuries

The link below is a video of a tennis player tearing their Achilles tendon.

http://www.youtube.com/watch?v=MLT5-Wnu594

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