ACHILLES TENDON TEAR OR RUPTURE

The Achilles tendon is a band of thick, fibrous tissue connecting the calf muscles to the heel bone. If the tendon fibers break completely or partially, it is called a tear or rupture and may need immediate medical attention.

Schedule an Appointment

If your child needs surgery or casting, our Fracture Care Clinic opens every day and you do not need an appointment. Surgery rooms get scheduled every morning, so your child receives the care and attention they need right away.

Achilles Tendon Tear or Rupture

Achilles Tendon Tear or Rupture The Achilles tendon (or the calcaneal tendon) is a thick band of connective tissue located at the back of a lower leg. It is the largest and strongest tendon in the human musculoskeletal system that connects the calf muscles to the heel bone (calcaneus) of the foot. Although the Achilles tendon is built to handle great stress during activities like jumping and running, if your child overstretches it, it can tear partially or completely.

Achilles tendon tears or ruptures are more common in people who play recreational sports like soccer, tennis, basketball, etc. Generally speaking, sudden starts, stops, and falls are often the cause of an Achilles tendon tear or rupture. Also, note that men are more likely to rupture their Achilles tendons than women. In many cases, the injury heals with conservative treatment like rest and bracing. However, some people may need to have surgery to repair their ruptured Achilles tendon.

Causes of Achilles Tendon Tear or Rupture

An Achilles tendon rupture occurs when there is extreme stress on the tendon. For example, you may experience an Achilles tendon tear or injury while playing sports that involve sudden starts, stops, and pivots. It can also occur when you fall from a height, accidentally step into a hole, miss a step when going downstairs, or twist your ankle. What’s more, the use of certain antibiotics and steroid injections can weaken the tendon and increase the risk of a tear.

In general, Achilles tendon injuries occur in people who are in their 30s to 50s. However, it may affect children as well. Adults who participate in high-intensity training and activities only in their spare time are more likely to tear their Achilles’ tendons than younger athletes who train regularly. Obesity is another risk factor here. Excess weight means more stress on the tendon, resulting in tendon problems.

QUESTIONS AND ANSWERS

What Causes an Achilles Tendon Tear or Rupture?

An Achilles tendon tear or rupture is often caused by sudden and forceful movements, particularly during sports activities that involve quick changes in direction or jumping. Overuse and repetitive stress on the tendon can also lead to micro-tears that may eventually progress to a complete tear. Certain factors, such as age, poor conditioning, and the presence of pre-existing tendonitis, can increase the risk of Achilles tendon injuries.

What are the Symptons of an Achilles Tendor Tear or Rupture?

The most common symptom of an Achilles tendon tear is a sudden and severe pain at the back of the ankle or calf, often described as a “pop” or “snap” sensation. Swelling, bruising, and difficulty walking or standing on the affected leg are also typical signs. In some cases, a visible gap or indentation may be felt just above the heel, indicating a complete rupture.

How is an Achilles Tendon Tear or Rupture Treated?

The treatment approach for an Achilles tendon tear or rupture depends on the severity of the injury and the patient’s overall health. Non-surgical treatment options may be considered for partial tears or less severe injuries and can involve rest, immobilization with a cast or walking boot, physical therapy, and non-steroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation.

Immobilization: This is crucial for allowing the ends of the Achilles tendon to reattach and heal. Various devices such as a cast, splint, brace, or walking boot might be used, with complete healing potentially taking up to six months.
Rehabilitation: Whether opting for surgery or non-surgical methods, a rehabilitation program is essential. Physical therapy supports the healing process and helps restore mobility and strength.
Lifestyle Considerations: It’s important to avoid smoking, as it can slow down healing by decreasing blood supply and delaying tissue repair.

Surgical intervention is often recommended for complete tears or cases where non-surgical methods are not effective. Surgery involves reattaching the torn tendon and may be performed using traditional open surgery or minimally invasive techniques.

Choosing the Right Treatment

Deciding on the appropriate treatment involves multiple factors. Surgery might be the preferred option if:

You are young or physically active.
You wish to reduce the risk of a future rupture, as surgery tends to lower the likelihood of another rupture compared to immobilization.

Conversely, you might opt against surgery if:

You are older or less active.
You want to avoid surgery risks, such as infection.

Consulting with a healthcare professional is vital to weigh the pros and cons of each treatment option. They can guide you in making an informed decision that aligns with your personal health goals and lifestyle.

Achilles Tendon Tear or Rupture Symptoms

When the Achilles tendon ruptures, you may hear a snapping or popping sound at the back of your ankle. You may also experience sharp pain in that region. Many people describe it as a kick or hit in the calf. Typically, people with a torn Achilles tendon find it hard to walk properly. Other common symptoms include swelling and bruising near the heel, tenderness at the back of the lower leg, an inability to stand on the toes, etc.

Complications

An Achilles tendon tear or rupture requires medical attention. Without proper treatment, the injury may not heal perfectly. As a result, the tendon may rupture again in the future.

Achilles Tendon Tear or Rupture Diagnosis

If you hear a snap or pop near your heel or ankle and you feel immediate pain when walking afterward, you should see your doctor. This could indicate a problem with your Achilles tendon.

Call your doctor immediately if you notice any of the following:

Intense pain at the back of your heel and ankle.
A sharp pain that feels like a direct hit to your Achilles tendon.
Swelling in the Achilles tendon area.
Difficulty walking comfortably.

Additionally, watch for signs of nerve or blood vessel damage, such as:

Numbness or tingling.
A pins-and-needles sensation in your foot.
Pale or bluish skin tone.

If you’ve had a previous Achilles tendon injury and suspect a reinjury, it’s crucial to contact your doctor to discuss the next steps. Until you receive medical advice, make sure to rest your lower leg and foot to prevent further damage.

First, your healthcare provider will perform a thorough physical examination of the area around your ankle and heel. He will look for signs of pain when he presses or moves the tendon. He may ask you to move your foot and ankle in different directions to see how you react to it. What’s more, he will examine your lower leg for any knots on the back of your leg, small bumps, and swelling or tenderness near the heel.

Your doctor may use various tests to diagnose an Achilles tendon sprain or rupture. These include:

MRI (Magnetic Resonance Imaging) – It is a medical imaging technique that produces detailed images of the leg and ankle using a magnetic field and computer-generated radio waves. The images help the doctor determine the best option to treat the injury.
Ultrasound – It is an imaging technique that uses sound waves to produce images of the Achilles tendon.
X-rays – Your healthcare provider may also take X-rays of your lower leg and foot to find bone spurs or hardening of the tendon’s lower part.

Other tests used to diagnose Achilles tendon injuries include the Thompson test and the Matles test.

Schedule an appointment today to treat your child for an Achilles Tendon Injury

What Are the Components of Physiotherapy and Rehab for an Achilles Tendon Injury?

Recovering from an Achilles tendon injury involves a comprehensive rehabilitation program tailored to your specific needs. Whether you’re dealing with a partial tear or a full rupture, physiotherapy serves as a cornerstone of recovery, aiming to restore your tendon’s function and alleviate discomfort.

Key Elements of Rehab for Achilles Tendon Injuries:

Customized Exercise Programs

Personalized exercises are vital. Stretching and flexibility workouts help ensure the tendon heals without shortening, which could lead to persistent pain. Strengthening routines focus on rebuilding the tendon’s power, reducing the risk of reinjury.

Therapeutic Techniques

Ultrasound Heat Therapy: This technique boosts blood flow, potentially speeding up the healing process.
Deep Massage: Aids in enhancing flexibility and circulation in the lower leg, offering added protection against future injuries.

Endurance and Cardiovascular Activities

Engaging in low-impact exercises, such as using a stationary bike, helps maintain cardiovascular fitness while minimizing stress on the tendon.

Coordination and Agility Training
These activities focus on improving overall balance and muscle coordination, crucial for a safe return to everyday activities and sports.

Your journey to recovery will be guided by your healthcare team, ensuring your rehabilitation is both effective and safe. Whether surgery is part of your treatment or not, a well-rounded rehab program is essential for a successful return to full activity.

Treatment and Management

Treatment options for a torn or ruptured Achilles tendon include conservative treatment and surgery. In most cases, the healthcare provider first recommends non-surgical treatment methods to treat the ruptured Achilles tendon. The doctor may also recommend surgery depending on the extent of injury you have and your circumstance.

Non-Surgical Treatment and Pain Management: Your doctor will advise you to follow the RICE method to reduce pain and swelling. It includes:

Rest – You need to avoid all physical activities that put stress on the Achilles tendon. These include running, jumping, etc. However, you may do low-impact activities such as swimming. But before that, you must consult with your healthcare provider.
Ice – Apply ice to the area around the injured tendon for 15-20 minutes every two to three hours throughout the day. Ice is a great tool for alleviating pain and swelling. Nonetheless, make sure you wrap the ice in a light, absorbent towel before applying it to the skin to avoid frostbite.
Compression – You need to wrap your ankle and heel with an elastic medical bandage to prevent swelling. However, make sure the bandage is not too tight. Otherwise, it will interrupt the blood flow in that region.
Elevation – It is another effective way to reduce pain, swelling, and throbbing. You need to keep your foot and ankle raised above the level of your heart as long as you can.

Additionally, follow these self-care strategies to support your recovery and prevent further injury:

Pain Relief – Consider taking over-the-counter pain relievers such as acetaminophen or NSAIDs. Always read and follow all instructions on the medication label to ensure safe use.
Follow Physiotherapy – Engage in a prescribed physiotherapy program involving gentle stretching and strengthening exercises, especially focusing on calf stretches.
Avoid Tobacco – Refrain from smoking or using other tobacco products, as these can slow healing by decreasing blood supply and delaying tissue repair.
Proper Footwear – Wear quality athletic shoes that support your arches and cushion your heels. Consult with a physiotherapist or podiatrist about using heel pads or orthotics for additional support.
Night Brace – Your doctor might suggest using a night brace if your Achilles tendon tends to shorten and stiffen during sleep. This brace helps keep your foot in a neutral position.

By integrating these strategies into your recovery plan, you can enhance your healing process and return to regular activities more effectively.

If the pain is severe, your healthcare provider may place your leg in a walking cast or brace. You may also need physical therapy to regain strength and mobility in the tendon. Also, your doctor will give you nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain.

With non-surgical treatment methods, it may take about four to six months for the torn Achilles tendon to heal completely.

Surgery: The surgical repair involves stitching the two ends of the torn or ruptured Achilles tendon back together. The surgeon will make a small incision in the back of your lower leg and reattach the ends of the torn tendon. You will need to use a walking cast after surgery to immobilize the tendon.

What is Involved in a Rehabilitation Program for an Achilles Tendon Injury?

Rehabilitation plays a crucial role in the recovery from an Achilles tendon injury. Whether dealing with a partial tear or a complete rupture, a well-designed rehab plan is essential to restore your mobility and reduce pain.

Here’s what you can expect:

Tailored Plans & Professional Guidance

Your doctor or physiotherapist will create a personalized rehabilitation program. Whether you’ve opted for surgical intervention or not, rehab remains a cornerstone of recovery.

Key Components of Rehab:

Flexibility and Stretching Exercises: These exercises are vital to ensure that your tendon heals properly without becoming shortened, which could lead to chronic pain.
Strength Training: Building strength in the tendon is crucial. Not only does it aid recovery, but it also shields you from potential future injuries.
Ultrasound Heat Therapy: By enhancing blood flow to the affected area, ultrasound therapy may speed up the healing process.
Deep Tissue Massage: This helps improve flexibility and circulation in the lower leg, aiming to prevent additional injuries.
Endurance Workouts: Activities like riding a stationary bike are often incorporated to help maintain cardiovascular fitness without overstraining the tendon.
Coordination and Agility Exercises: These focus on returning you to your pre-injury movement patterns and are essential for regaining full function.

Commitment to Recovery

Engaging fully with all aspects of your rehab program not only supports healing but also promotes long-term tendon health. Each component is designed to work synergistically, ensuring that you bounce back stronger and more resilient.

What Are the Benefits and Risks of Surgery for an Achilles Tendon Tear?

If you’ve torn your Achilles tendon, you might be weighing the decision of whether or not to undergo surgery. It’s important to understand both the benefits and risks before making this choice.

Benefits of Surgery

Lower Risk of Re-Rupture: Surgical repair often results in a significantly reduced chance of tearing the tendon again. This is a key consideration if you’re concerned about future injuries.
Ideal for the Young and Active: For younger individuals or those with an active lifestyle, surgery can restore function more effectively, allowing a quicker return to physical activities and sports.
Enhanced Healing Process: Surgery typically promotes more robust healing, as it directly repairs the damaged tendon, which can lead to better strength and mobility post-recovery.

Risks of Surgery

Surgical Complications: Like any surgical procedure, there are inherent risks such as infection, nerve damage, or adverse reactions to anesthesia. These complications are relatively rare but should be considered.
Recovery Time: The surgical recovery process can be lengthy and involves a commitment to post-operative rehabilitation. This might be a deterrent if immediate functionality is a primary concern.
Not Suitable for Everyone: Older adults or those with a less physically demanding lifestyle might find the risks outweigh the benefits, especially if they prefer to avoid invasive procedures.

Your healthcare provider can help you weigh these factors based on your specific situation, aiding in the decision that best suits your health and lifestyle goals.

What is the Watchful Waiting Approach for an Achilles Tendon Tear?

The watchful waiting approach involves monitoring your symptoms over time without immediate medical intervention. It’s suitable if your Achilles tendon issue is mild and not debilitating. This method allows you to observe whether symptoms improve or worsen naturally with rest and basic care.

When to Consider Watchful Waiting

Mild Symptoms Only: If you experience slight discomfort or minor swelling, resting your leg and foot for a few days might be beneficial.
Initial Signs: Ideal during the early stages when you first notice the issue.

When to Seek Immediate Care

Watchful waiting isn’t suitable for everyone. Seek professional medical advice if you encounter:

Severe Pain: Intense discomfort that disrupts daily activities.
Persistent Weakness: Difficulty in movement or lack of strength.
Ongoing Cramping: Frequent muscle spasms that don’t subside.
Consistent Pain: Pain that remains constant or worsens over time.

Effective Steps for Watchful Waiting

Rest: Minimize activities that strain your lower leg.
Elevate: Keep your foot elevated to reduce swelling.
Monitor: Observe any changes in symptoms over a few days.
Consultation: If improvements aren’t noted, or symptoms worsen, reaching out to a healthcare provider is crucial.

By closely observing your body’s responses, watchful waiting can be a practical approach, but always be prepared to act promptly if symptoms deteriorate.

Risk Factors

Here are some factors that increase the chances of an Achilles tendon sprain or rupture:

Tendon ruptures usually occur in people between the ages of 30 to 40. Nevertheless, it can also occur in kids who participate in sports like soccer, tennis, etc.
Men are up to five times more likely to rupture their tendons than women.
Steroid injections at the ankle joint can weaken nearby tendons and increase the risk of tendon ruptures.
People who play recreational sports like basketball, tennis, and soccer are at a higher risk of rupturing their tendons. It’s because these sports involve sudden starts, stops, and pivots which are a major cause of Achilles tendon injury.
Since excess weight places more stress on the tendon, people who are overweight or obese are more likely to experience Achilles tendon injuries.

How to Prevent Achilles Tendon Injuries?

Here are some ways to reduce the risk of Achilles tendon injuries:

Do calf-stretching and calf-strengthening exercises on a regular basis.
Avoid physical activities that put extreme stress on the Achilles tendon.
Mix high-impact sports with low-impact sports and activities such as walking or swimming.
Increase the intensity of training in a slow and gradual manner.
Avoid running or jumping on hard or slippery surfaces.

Final Thoughts

Always consult with your doctor if your child has pain and swelling near the ankle or heel, especially if your child heard a snap or pop at the back of the lower leg. If you come to one of our Medical City Children’s Orthopedics & Spine Specialists offices in Arlington, Dallas, Flower Mound, Frisco, and McKinney, Texas, our pediatric orthopedic doctors will examine your child’s leg and recommend the best treatment option to repair the problem and get your child back playing. We specialize in Children and treat them for minor conditions and the most complex ones as well.

_____________________

Footnote:

American Academy of Orthopedic Surgeons: Achilles Tendon Rupture

Call 214-556-0590 to make an appointment.

Comprehensive services for children from birth through adolescence at five convenient locations: Arlington, Dallas, Flower Mound, Frisco and McKinney.