Achilles Tendon Rupture

An Achilles tendon rupture occurs when the tendon completely tears, usually during activities that involve sudden, forceful movements or abrupt changes in direction. This injury is common among athletes, though it can affect individuals of all activity levels. Ruptures typically happen 2 to 6 centimeters above the heel in the area where the tendon has poor blood supply. This “watershed” area is the most common rupture site due to reduced vascularity, high mechanical stress, and tendon degeneration.

The injury can be classified as either partial or complete. A partial rupture involves damage to some of the tendon fibers, while a complete rupture means the tendon has torn entirely, disconnecting the calf muscle from the heel. Without a fully functioning Achilles tendon, basic activities such as walking or climbing stairs can become difficult.

An cchilles tendon rupture can result from various factors, most of which are associated with sudden stress or trauma to the tendon. Some of the most common causes include:

1. Sudden Increase in Physical Activity – A sharp increase in the intensity or frequency of physical activity can lead to an Achilles tendon rupture. This often occurs in individuals who participate in recreational sports, such as basketball, soccer, tennis, or pickleball, which require jumping or pushing off forcefully, quick pivots, rapid changes in direction or explosive movements.
2. Improper Warm-Up or Conditioning – Insufficient stretching and poor conditioning can leave the Achilles tendon vulnerable to injury. Tight calf muscles or limited flexibility may place additional stress on the tendon.
3. Direct Trauma – A direct impact to the Achilles tendon can cause it to rupture. This may happen during sports, falls, or motor vehicle/motorcycle accidents.
4. Degeneration of the Tendon – Over time, the Achilles tendon may weaken due to age, overuse, or degenerative conditions such as tendinosis. The tendon becomes less flexible and more prone to injury as individuals grow older.
5. Certain Medications – Some medications, particularly corticosteroids and certain antibiotics (like fluoroquinolones), are linked to an increased risk of tendon rupture by weakening the tendon structure.
6. Medical Conditions – Conditions such as obesity, diabetes, and arthritis can contribute to poor tendon health, increasing the likelihood of rupture.

No, there aren’t typically any warning signs before an Achilles tendon rupture.

Achilles tendon rupture often present with distinct and sudden symptoms, making it relatively easy to recognize. The most common symptoms include:

1. Sudden Pain – Many patients describe feeling a sharp, stabbing pain in the back of the ankle or calf at the moment of injury. A feeling of being kicked in the calf. Some report hearing or feeling a “pop” at the time of rupture.
2. Swelling and Bruising – Swelling often develops quickly around the heel and lower calf or back of the ankle. Bruising may appear within hours of the injury.
3. Difficulty flexing the foot downward, making it difficult to walk, walk downhill, or stand on your toes – After a rupture, patients frequently experience difficulty bearing weight on the affected leg. Standing on tiptoes or pushing off the ground becomes challenging or impossible.
4. Visible Indentation – In cases of complete rupture, there may be a visible indentation or gap in the tendon above the heel.
5. Weakness in the Foot and Ankle – The inability to push off the foot or generate power during movement can signify a torn Achilles tendon.

Diagnosing an Achilles tendon rupture typically involves a combination of physical examination and imaging tests. A prompt and accurate diagnosis is essential to developing an appropriate treatment plan.

Physical Examination

During the initial evaluation, Dr. Boden will ask about the patient’s medical history and the nature of the injury. Next, a thorough examination will be performed to assess symptoms and identify the site of the rupture. A complete Achilles tendon rupture can often be a purely clinical diagnosis based on physical examination.

One common diagnostic test is the Thompson Test. The patient lies face down with their feet hanging off the examination table or with their knees bent to 90 degrees. The resting tension of the foot is observed and the calf muscle is gently squeezed. If the foot does not plantarflex, it suggests a rupture in the Achilles tendon. If the resting tension of the injured side is less than the other side, or there is an increase in passive dorsiflexion, this also suggests a rupture of the Achilles tendon.

Imaging Tests

In cases where the physical exam results are inconclusive or further confirmation is required; imaging tests may be necessary.

• Ultrasound – This imaging technique provides real-time images of the tendon, allowing physicians to assess the extent of the tear. Ultrasound is often used because it is quick, non-invasive, and highly effective.
• MRI (Magnetic Resonance Imaging) – An MRI offers detailed images of soft tissues and can help evaluate partial tears, degenerative changes, the location of the rupture, any insertional involvement or other abnormalities in the tendon. This test is particularly useful for planning surgical interventions.
• X-rays – While X-rays do not show soft tissue injuries, they may be used to rule out fractures or other bone-related issues.

Once a diagnosis is confirmed, Dr. Boden works with patients to develop a personalized treatment plan based on the severity of the rupture, activity level, and overall health. In some cases, conservative treatments such as immobilization and physical therapy are sufficient, while some injuries may require surgical intervention to restore full function and help prevent re-injury.