PATHOLOGIES

TENDON AND SOFT TISSUE CONDITIONS

Achilles Tendon Ruptures: Acute & Chronic

What is it?

An Achilles tendon rupture occurs when the Achilles tendon — the strong, fibrous tissue that connects the calf muscles (gastrocnemius and soleus) to the heel bone — is partially (rare) or completely torn. The rupture can result from sudden movements or repetitive strain, often during activities such as running, jumping, or pivoting.

Types

There are two main types of Achilles tendon ruptures:

Acute Achilles Tendon Rupture: A sudden, traumatic tear that occurs at the time of injury.
Chronic Achilles Tendon Rupture: A long-standing rupture that occurs after untreated or poorly managed tendon injuries, leading to degeneration and eventual rupture.

CAUSES

Acute Rupture:

Sudden, forceful movement: Quick starts, stops, or changes in direction (common in sports like basketball, tennis, or soccer)
Direct trauma: A sudden blow or impact to the Achilles tendon can cause it to rupture
Weakness in the tendon: If the tendon has been weakened by previous injuries or overuse, it is more susceptible to rupture

Chronic Rupture:

Untreated tendinopathy: Long-term tendon degeneration due to repetitive strain or chronic inflammation of the Achilles tendon, also known as Achilles tendinopathy
Poor healing from prior injury: An untreated partial tear may progress into a full rupture over time
Age and wear: Tendons lose elasticity with age, making them more prone to injury
Imbalance in muscle strength: Weak calf muscles or poor flexibility may increase strain on the Achilles tendon

SYMPTOMS

Acute Achilles Tendon Rupture:

Sudden sharp pain in the back of the ankle, often described as being kicked or struck
Swelling around the Achilles tendon and ankle
Inability to push off the foot or walk on tiptoe
A gap or indentation can often be felt in the tendon where the rupture occurred
Bruising and tenderness in the affected area

Chronic Achilles Tendon Rupture:

Persistent pain in the back of the ankle, particularly after activity
Swelling and a feeling of stiffness in the tendon
Limited range of motion in the ankle joint
Weakness in the calf muscles, especially when pushing off with the foot
Abnormal gait: Difficulty walking or running due to tendon dysfunction

DIAGNOSIS

Physical examination: A doctor will check for signs of swelling, bruising, and tenderness, and perform specific tests, such as the Thompson test, where the calf muscle is squeezed to see if the foot moves (inability to move the foot suggests a rupture)
Ultrasound: An ultrasound can be used to visualize the tendon and detect tears (rarely necessary in the acute setting)
MRI: An MRI provides detailed images of the tendon, helping determine the size and location of the rupture (rarely necessary in the acute setting)
X-rays: X-rays may be used to rule out bone fractures but do not show soft tissue injuries like tendon ruptures

TREATMENT OPTIONS

Acute Rupture:

Non-Surgical Treatment:

Rest and immobilization: The foot and ankle will be immobilized in a cast, boot, or brace to allow the tendon to heal in the proper position (if treated in the first 3-5 days)
Physical therapy: Once the tendon is healed enough, rehabilitation exercises will be started to restore strength, flexibility, and function
NSAIDs: Nonsteroidal anti-inflammatory drugs (e.g., ibuprofen) to manage pain and reduce swelling

Surgical Treatment:

Surgical repair: Surgery may be necessary to reconnect the two ends of the ruptured tendon, especially in active individuals or those with significant tendon damage. The procedure involves stitching the tendon back together, sometimes with a graft if the tear is large
Post-surgery rehabilitation: After surgery, the tendon will be immobilized in a cast or boot for several weeks, followed by physical therapy to restore function