Achilles Tendon InjuryThe Achilles tendon is the thickest and strongest tendon in the body. The Achilles tendon is fibrous tissue that connects the heel bone to the gastrocnemius and soleus muscles, otherwise known as the calf muscles. 

Contracting the calf muscles pulls the Achilles tendon, which pushes the foot downward, otherwise, known as plantar flexion. This contraction enables: standing on the toes, walking, running, and jumping.  You rely on it virtually every time you move your foot. 

If you overstretch your Achilles tendon, it can tear (rupture). Athletic exertion is noted to be the mechanism of injury in 81% to 89% of ruptures. The tendon can rupture completely or just partially.

An Achilles tendon rupture, might feel a sudden pop or snap, or a sense that something struck the calf, followed by an immediate sharp pain in the back of the ankle and lower leg that usually affects the ability to walk properly. This pain may then subside quickly. 

Recognition of a rupture can be identified by a visible or palpable gap that may be felt along the Achilles tendon approximately 4-6cm above the top back border of the heel bone. Weakness will be noted in plantarflexion. 

Factors that may increase the risk of Achilles tendon rupture include:

  • Age. The peak age for Achilles tendon rupture is 30 to 40.
  • Gender. Achilles tendon rupture has a much high occurrence in men than in women.
  • Recreational sports. Achilles tendon injuries occur more often in sports that involve running, jumping, and sudden starts and stops—such as football, soccer, basketball, and tennis.
  • Steroid injections. Injected steroids can weaken tendons and have been associated with Achilles tendon ruptures.
  • Certain antibiotics. Fluoroquinolone antibiotics, such as ciprofloxacin (Cipro) or levofloxacin (Levaquin), increase the risk of Achilles tendon rupture.  The elderly have been shown to be more susceptible to this. 

Non-surgical and surgical options exist for treatment. Non-operative measures include casting and functional bracing.

Surgical repair has evolved to both open and percutaneous (through the skin using small incisions).  

Considerable debate remains regarding the optimal treatment of acute Achilles tendon ruptures, and management strategy is decided on an individual basis.

Recent studies have shown functional outcomes to be similar in both treatment methods.  Surgical methods have been shown to have slightly lower Achilles re-rupture rates, but higher complication rates.

In general, surgical treatment has been considered preferable for younger patients and those in good physical condition. Non-surgical treatment is an acceptable method especially for the older and patients with lower sporting requirements. 

Regardless of the treatment method for an acute Achilles tendon rupture, an accelerated rehabilitation protocol including functional bracing, early range of motion, progressive resistance training, and early weight-bearing is recommended for improved recovery.