The Achilles tendon is the strongest tendon in the human body. It transmits forces from the calf muscles to the heel bone which enables the ability to walk, jump and run. Most Achilles tendon ruptures occur during sports activities due to a sudden, strong force. A rupture can also result from tendon degeneration. Multiple factors contribute to tendon disease and the risk of a rupture, including gender, genetic predisposition, steroid injections, overuse, and aging; and some medical conditions such as obesity, type 2 diabetes, and high cholesterol.

What is Achilles tendinopathy?

It is any tendon condition that causes pain, swelling and thickening of the Achilles tendon due to chronic inflammation. Tendinopathy is a sign of tendon degeneration. Sports that can cause tendinopathy include running, baseball, basketball, golf, skiing, soccer, swimming, and tennis. It can result from years of wear and tear or from repetitive use that causes microtraumas that weaken the tendon. Tendinopathy compromises sports performance and may prevent active athletes from participating in activities of daily life and may lead to a rupture and a career- ending injury.

What is an Achilles tendon rupture?

A rupture is a tear in the tendon. It may be partial or complete. The tendon may tear in the middle of the calf, or at the heel. A tear can occur spontaneously because of a degenerated tendon and typically affects people over age 60, but it can also result from a high energy sport or from a sudden trauma to the calf muscle. It can affect athletes and healthy active individuals. Acute ruptures tend to affect middle aged individuals.

What are the symptoms of a rupture?

• Sudden sharp pain in the heel and back of the ankle
• Hearing or feeling a snap or pop in the heel
• Inability to walk or stand on tiptoes
• Swelling and bruising

How is an Achilles rupture diagnosed?

An Achilles tendon rupture is diagnosed by signs and symptoms and physical exam. Ultrasound and MRI are useful to assist in diagnosis.

What are the treatments for an Achilles tendon rupture?

Treatment options depend on the severity of the injury, age, and activity level. Achilles tendon repair surgery is often advised for a ruptured Achilles tendon in patients aged 30-50. Outpatient surgery is often recommended for young to middle aged active patients. It may be accomplished with open surgery or minimally invasive surgery.

Achilles tendon repair surgery involves sewing together the torn ends of the tendon. If the tendon is degenerated, the damaged part is removed, and the rest of the tendon is sewn together. When the tendon is severely damaged/degenerated, it will be removed and replaced with a tendon harvested from another area of the body. It can take 4-6 months for complete healing.

Nonsurgical treatment may be recommended for young patients with an acute sports injury. Treatment involves immobilization and rehabilitation. Nonsurgical treatment can restore good function but can increases the risk of re-rupture.

Rehabilitation after Achilles rupture repair

Early functional rehabilitation will vary greatly depending on the type of acute Achilles tendon rupture and repair. Rehabilitation is integral to restoration of pre-injury activity level. Recent studies report that functional rehabilitation is more effective in reducing re-rupture rates than long-term cast immobilization and functional improvement after conservative management is comparable to that after open surgical repair.

At CAO sports performance we specialize in athlete rehabilitation, enhanced performance training, injury prevention and evidence-based physical therapy. We have offices in Leonardtown, Waldorf and California, Maryland.