What is an Achilles tendon rupture or tear?
An Achilles tendon rupture is the term for tissue damage that results in a complete tear of the Achilles tendon. If the Achilles tendon is only partially torn it is classed as a tear rather than a rupture. The tendons in the body connect muscle to bone and their structure is very similar to a rubbery, stretchy cord making it strong, durable and flexible. Where the tendons attach to the bone they are covered in a sheath that is lubricated on the inside allowing the tendon to move in and out effortlessly. Joint movement is the end result of your muscle fibres contracting and pulling on the tendon, which in turn tugs at the bone producing the movement.
The Calf muscles are made up of the gastrocnemius which originates just above the back of the knee and soleus which originates just below the back of the knee. Both muscles overlap and run down the back of the leg down to the foot and attach onto the heel (the calcaneus) via the Achilles tendon. The calf muscles are responsible for plantar flexing the foot (pointing the foot downwards) and the gastrocnemius contributes to flexing the knee. A rupture or tear of the tendon makes any movement of the tendon very painful and weak.
Why & when does an Achilles tendon Rupture or tear happen?
An Achilles rupture or tear is a common injury and is normally seen between the ages of 20 and 40 however tendonitis of the Achilles tendon is a more common injury. Ruptures or tears are normally seen in individuals who partake in a lot of athletic sports in particular running, tennis and football where quick and forceful directional changes need to be made. These activities involve repetitive or forceful plantar flexion of the ankle and foot placing a lot of pressure through the Achilles tendon. Achilles ruptures are less common than partial tears and are normally the result of a severe traumatic injury. There are certain factors such as tight calf muscles, previous Achilles injuries and poor foot posture or dysfunction that make you more prone to suffering a rupture or tear.
What does an Achilles tendon rupture and tear feel like?
An Achilles tendon rupture causes a very intense immediate severe sharp pain around the back of the ankle, a partial tear of the tendon will also feel sudden and sharp but the pain will be less severe than that of a rupture. The pain will radiate up into the shin, calf and knee and down into the foot. In some cases a tearing or snapping noise is heard during the injury. The tear and rupture will be accompanied by severe swelling and bruising that will be incredibly tender to touch. In cases of rupture there will possibly be visible joint deformity. Pain levels will be aggravated by any foot movements making weight bearing and walking excruciating and impossible in a rupture case. In partial tear cases patients can still fully use their ankle with stiffness and a feeling of discomfort on weight bearing resulting in a mild limp. Once healing the severe pain will be replaced with dull aches and discomfort felt on ankle plantar flexion or when the Achilles tendon is stressed. Stiffness and dull aches are normally experienced during the night and most intense early in the mornings.
How long does an Achilles tendon rupture or tear take to heal?
A mild partial Achilles tear can recover without surgical intervention, with the use of a cast and plenty of rest. The healing time can vary dramatically but with most Achilles tendon tears healing ranges from 6-8 months and in some cases as long as 12 months. Cases of Achilles tendon ruptures however take much longer to heal and almost always need surgical intervention. Post-surgery a cast is applied and the patient is immobilized for up to two months followed by up to 6 months’ worth of physical rehabilitation, a recovery to the original tendon’s strength can take well over a year.
How will an Achilles tendon rupture or tear be diagnosed?
Your GP or therapist will be able to diagnose you by both listening to your history and examining you. No X-rays or further investigation should be needed to confirm the diagnosis however occasionally an ultrasound or MRI will be used to evaluate the extent of the tear or rupture.
What treatment options are available for an Achilles tendon rupture or tear?
Your GP will most likely prescribe anti-inflammatory medication and painkillers for pain relief and to reduce any swelling. Initially you will be advised to follow the R.I.C.E protocol. The R.I.C.E protocol involves resting the ankle, trying not to walk about on it too much and most importantly avoiding all aggravating movements. Ice by applying a covered ice pack to the area may also significantly hasten the healing process by reducing the pain and swelling. Please make sure the ice pack is covered to prevent any ice burn and for best results use the icepack use regularly for 10-15 minutes with intervals of 30 minutes. Compression, try and keep an elastic bandage on during the day to limit the swelling and make sure to take it off at night. Elevation, keep the foot raised on cushions or a stool to help limit the swelling.
Your doctor will evaluate the extent of the tear or rupture. If the tear is partial then a cast or splint will be applied and you will be ordered to rest for as long as the healing process takes. In Rupture cases surgery is almost always necessary and is the best form of treatment to return the patient back to original function and strength. The surgery will stitch the tendon back together, after this a cast will be applied and the patient will be rested for 2 months at which point you will be referred through to a physiotherapist who will provide you with strengthening exercises for the lower limb muscles and Achilles tendon, this can take over 6 months. Full strength recovery is not guaranteed and can occasionally take well over a year to achieve. A good rehabilitation program can aid the healing process and prevent reoccurring injury.
Once into the later phase of recovery many people find massage therapy helpful to loosen the affected muscles, manipulative therapies such as physiotherapy, chiropractic and osteopathy are thought to help through mobilisation treatment of the ankle working to reduce any stiffness levels and return the joint back to its normal movement.
If your GP has mentioned or if in-fact you feel that there is some element of foot or ankle dysfunction that has predisposed you to this injury then it is very important that you see a podiatrist who can fully examine your feet and determine whether you need orthotics for your shoes. Often inappropriate and unsupportive running shoes are a factor in the development of ankle or foot conditions. The failure to do this may result in recurring cases of tendonitis.