According to statistics, the most Achilles tendon ruptures were recorded among people involved in active sports. This is an injury in which the tendon that connects the muscles of the back of the leg to the calcaneus is completely or partially torn.
With this damage, you can feel a click or crack, after which severe pain in the lower leg and back of the ankle sharply appears. Injury almost always makes it difficult to walk normally, and many doctors recommend surgery as the most effective treatment for rupture. However, more conservative approaches may also be effective.
Symptoms
Although Achilles tendon tendonitis and its subsequent rupture may be asymptomatic, most people notice one or more signs of damage:
- pain (often severe and accompanied by swelling in the ankle);
- inability to bend the foot in the downward direction or push the sore foot off the ground while walking;
- inability to stand on the tips of the fingers on the injured leg;
- clicking sound or cracking at the time of tendon rupture.
Even if there is no pain syndrome as such, it is necessary to seek medical advice immediately after you hear a click or crack in the heel, especially if immediately after this sound you have lost the ability to walk normally.
Causes
The Achilles tendon helps lower the movable part of the foot down, tip-toe, and kick off the ground while walking. It is somehow involved every time you move your foot.
Rupture usually occurs at a site six centimeters above the junction of the tendon with the calcaneus. This site is especially vulnerable, since blood circulation is difficult here. For the same reason, the tendon heals very slowly after an injury.
There are very common examples of Achilles tendon ruptures caused by a sharp increase in load:
- increased intensity of sports, especially if they include jumping;
- falling from height;
- hit the feet in the pit.
Risk factors
Some circumstances increase the risk of Achilles tendon rupture:
- Age. Most often, injuries of this type are observed in patients from thirty to forty years old.
- Floor. According to statistics, there are five men with a tendon rupture per woman patient.
- Doing sports. Most often, physical activity, including running, jumping and alternating sudden movements and stops, causes damage. Examples are football, basketball, tennis.
- Steroid injections. Doctors sometimes prescribe injections of steroids into the ankle joint to reduce pain and relieve inflammation. However, these substances can weaken nearby tendons and ultimately lead to rupture.
- Taking some antibiotics. Fluoroquinolones, such as Ciprofloxacin or Levofloxacin, increase the trauma of everyday activities.
Before a visit to the doctor
Given that a rupture (like just inflammation) of the Achilles tendon can lead to an inability to walk normally, you should immediately seek medical help. You may have to additionally visit a doctor specializing in sports medicine or orthopedic surgery.
In order for the consultation to be as effective as possible, immediately before receiving write down the following information on paper:
- a detailed description of the symptoms and the preceding case that caused the injury;
- information about past health problems;
- a list of all medications and nutritional supplements taken;
- questions that you would like to ask your doctor.
What will the doctor say?
The specialist is likely to ask you the following questions:
- How did tendon damage occur?
- Did you hear (or perhaps did not hear, but felt) a click or crack when injured?
- Can you stand on your fingertips on a damaged leg?
Diagnostics
At the initial medical examination, the doctor will examine the lower leg for sensitivity and swelling. In many cases, the specialist can manually sense the discrepancy in the tendon, if it has ruptured completely.
Your doctor may ask you to kneel on a chair or lie on your stomach on a table for examination so that your feet hang from the edge of the table. With this diagnostic method, the doctor compresses the patient's calf muscle to check for reflex: the foot should automatically bend. If it remains motionless, most likely, there was an inflammation of the Achilles tendon. It was she who ultimately led to injury.
If a question arose about the degree of damage (that is, did the tendon completely rupture or only partially), the doctor will prescribe an ultrasound scan or magnetic resonance imaging. Thanks to these painless procedures, you can take detailed pictures of any tissues and organs in the body.
Treatment
Many people to one degree or another damage the Achilles tendon. Treatment often depends on age, level of physical activity and the severity of the injury. In general, young patients and physically active people usually choose surgical intervention, this is the most effective method. Patients of older age groups are more likely to conservative treatment. According to recent studies, correctly prescribed conservative therapy may be no less effective than surgery.
Treatment without surgery
With this approach, patients usually wear special orthopedic shoes with a platform under the heel - it allows a torn tendon to heal independently. This method eliminates many operational risks, such as infection. However, recovering from orthopedic shoes takes much longer than treating an injury through surgery, and there is a high risk of re-tearing. In the latter case, you still have to resort to surgery, but there is a high probability that it will now be much more difficult for the surgeon to correct the Achilles tendon rupture.
Operation
Typically, surgery is as follows. The doctor makes an incision in the back of the leg and sutures the torn parts of the tendon. Depending on the condition of the damaged tissue, reinforcement of the sutures by other tendons may be required. Among the possible complications after surgery are infections and nerve damage. The risk of infection is significantly reduced if the surgeon makes small incisions during surgery.
Contraindications
Surgical treatment of Achilles tendon ruptures is contraindicated in those who are diagnosed with an active stage infection or a skin disease in the area of injury. Conservative therapy is also prescribed for patients with general poor health, diabetes, and smoking addiction. Contraindications are also such circumstances as a sedentary lifestyle, the use of steroids and the inability to follow the postoperative instructions of the surgeon. Any questions about the state of health should first be discussed with your doctor.
Rehabilitation
To permanently cure the Achilles tendon rupture (it does not matter after surgery or conservative therapy), you will be prescribed a rehabilitation program that includes physical exercises to train the muscles of the legs and the Achilles tendon. Most patients return to their normal lifestyle four to six months after the end of therapy or surgery.
Exercises
After conservative treatment, rehabilitation exercises can begin immediately after the disappearance of the pain syndrome, after surgery, as soon as the surgical wound heals. Physical activity is the key to full recovery from injuries (especially if this injury is an Achilles tendon rupture). Rehabilitation begins with massage and an increase in overall ankle mobility - the feeling of stiffness should disappear. After two weeks of gentle therapy, active exercises are prescribed, and the best results can be achieved by illuminating the much-needed physical activity from 12 to 16 weeks. The load begins with stretching, then proceed to strength exercises, including bending and straightening the knee.
If the pain syndrome has completely passed, you can connect a more sports-oriented load to training. It is advisable for athletes to go jogging and make more jumps. Recurrent tendonitis of the Achilles tendon and its subsequent rupture will become much less likely if the patient carefully adheres to the prescribed rehabilitation measures.