The Achilles tendon can grow weak and thin with age and lack of use. Then
it becomes prone to injury or rupture. Certain illnesses (such as arthritis anddiabetes) and medications
(such as corticosteroids and some antibiotics) can also increase the risk of rupture.
- Rupture most commonly occurs in the middle-aged
male athlete (the weekend warrior who is engaging in a pickup game of basketball, for example). Injury often occurs during
recreational sports that require bursts of jumping, pivoting, and running. Most often these are tennis, racquetball, basketball,
- The injury can happen in these situations.
- You make a forceful push-off with your
foot while your knee is straightened by the powerful thigh muscles. One example might be starting a foot
race or jumping.
- You suddenly trip or stumble, and your
foot is thrust in front to break a fall, forcefully overstretching the tendon.
- You fall from a significant height.
- A sudden and severe pain may be felt at the back of the ankle or calf—often described
as "being hit by a rock or shot."
- The sound of a loud pop or snap may be reported.
- A gap or depression may be felt and seen in the tendon about
2 inches above the heel bone.
- Initial pain, swelling,
and stiffness may be followed by bruising and weakness.
pain may decrease quickly and smaller tendons may retain the ability to point the toes. Without the Achilles tendon, though,
this would be very difficult.
- Standing on tiptoe and
pushing off when walking will be impossible.
- A complete tear is
more common than a partial tear.
The objective of treatment
is to restore normal length and tension to the tendon and allow you to do what you could do before the injury. Treatment
reflects a balance between protection and early motion.
- Protection is necessary to allow time for healing and to prevent reinjury.
your foot and ankle is needed to prevent stiffness and loss of muscle tone.
- Treatment options are
surgical or nonsurgical. The choice is controversial.
- Both surgical and nonsurgical treatment will require an initial period of about 6 weeks of casting or special braces.
The cast may be changed at 2- to 4-week intervals to slowly stretch the tendon back to its normal length. Casting may
be combined with early movement (1-3 weeks) to improve overall strength and flexibility.
heel lift device and regular physical therapy follow for the remainder of treatment.
with an orthopedic surgeon will determine the treatment and follow-up that is right for you.