Achilles Tendon Tears
Achilles tendon tears (ruptures) occur when the tendon that attaches the calf muscle to the heel bone tears.
The Achilles tendon tears when a movement pushes the toes upward (toward the shin) too forcefully or when a person is running or jumping forcefully.
The calf is very painful and walking is difficult, particularly when the tear is complete.
Doctors can usually diagnose Achilles tendon tears based on results of the physical examination.
Treatment usually consists of referral to an orthopedic surgeon and an ankle splint or, for some complete tears, surgery.
Achilles tendon tears are common. The tendon may be partially or completely torn.
Achilles tendon tears occur most often in athletes and middle-aged sedentary men, particularly those who are out of shape and start an intense activity or sport without gradually building up to it. The tendon is more likely to be completely torn in middle-aged men than in athletes. These injuries can occur when people do not warm up or stretch enough before intense activity. Typically, the injury occurs while running or jumping, especially if the sport requires quick changes in directions. The tendon tears when a movement pushes the toes upward, toward the shin, too forcefully and too far.
Rarely, the Achilles tendon tears with no apparent cause in people who take fluoroquinolone antibiotics (such as ciprofloxacin) or corticosteroids.
Doctors can usually diagnose Achilles tendon tears based on the physical examination.
To check for this tear, doctors do the following:
They squeeze the calf of the injured leg while the person is lying face down. If squeezing does not cause the ankle to flex or the ankle barely flexes, the tendon is completely torn.
They ask the person to lie down and bend their knees. Usually in this position, the ankle is slightly flexed. If it does not flex, the tendon is torn.
They gently feel along the Achilles tendon to check for a gap while the person is standing on the injured leg (if possible). If they detect a gap, the tendon is torn.
Sometimes magnetic resonance imaging (MRI) is done. However, a physical examination is more likely to detect an Achilles tendon tear.
People with an Achilles tendon tear are usually referred to an orthopedic surgeon.
For partial and complete tears, a short leg splint is applied to the injured leg in the emergency department. The splint holds the foot so that the toes are pointed down (called plantar flexion). This position prevents the Achilles tendon from stretching and helps the tear heal. The splint is worn for a short time. Then an orthopedic surgeon decides whether applying a cast or doing surgery to repair the tendon is better. People with an Achilles tendon tear should not put weight on the injured ankle and should use crutches.
Partial tears that continue to cause symptoms for 3 months or more may need to be surgically repaired.