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What is an Achilles’ Tendon Rupture?

The Achilles tendon is the largest tendon in the body and is involved in all different types of movement. Due to the strain it experiences, it is prone to injury. An Achilles tendon rupture is one such injury. It can occur in the young and the elderly, the active and the sedentary. Treatment depends on the injury and the patient’s goals. An orthopedic surgeon can help guide patients to the best treatment for them.

Achilles' Tendon Rupture

What is Normal Ankle Anatomy?

The Achilles tendon runs along the back of the ankle. The ankle is a joint where multiple bones meet. The two bones of the shin, the tibia and fibula, meet the bones of the foot. Two calf muscles converge to form the strong, fibrous Achilles tendon that runs down the back of the ankle and terminates at the heel bone, the calcaneus. The function of the Achilles tendon is to connect the calf muscles to the foot. This allows the foot to flex, enabling running, jumping, and many other motions that have been vital to human evolution.

What’s the difference between Achilles Tendinopathy and Achilles Tendon Rupture?

Some people may have heard of Achilles tendinopathy in addition to Achilles tendon rupture and may not understand the difference between the two. Tendinopathy describes pain or stiffness of the tendon and can be acute or chronic. Acute pain normally occurs with athletes who suddenly increase their activity. A classic example is a runner who starts training for a marathon. The pain builds gradually over a period of days to weeks. Chronic pain can be caused by poor running form, poor footwear, or low but sustained mechanical stress. Pain typically improves with rest.

Achilles tendon rupture is different. It is a sudden event, typically associated with a sudden increase in force. For example, a sudden pivot or abrupt stop-and-go motion can cause the tendon to experience a rapid increase in force. If the force overwhelms the strength of the tendon, the tendon can rupture. Certain medications, like ciprofloxacin, can make people more prone to rupture. Patients who have experienced a ruptured Achilles tendon often complain of a “popping” sensation followed by sudden, severe pain.

Achilles Tendinopathy

What is the Treatment for an Achilles Tendon Rupture?

Some people may have heard of Achilles tendinopathy in addition to Achilles tendon rupture and may not understand the difference between the two. Tendinopathy describes pain or stiffness of the tendon and can be acute or chronic. Acute pain normally occurs with athletes who suddenly increase their activity. A classic example is a runner who starts training for a marathon. The pain builds gradually over a period of days to weeks. Chronic pain can be caused by poor running form, poor footwear, or low but sustained mechanical stress. Pain typically improves with rest.

Achilles tendon rupture is different. It is a sudden event, typically associated with a sudden increase in force. For example, a sudden pivot or abrupt stop-and-go motion can cause the tendon to experience a rapid increase in force. If the force overwhelms the strength of the tendon, the tendon can rupture. Certain medications, like ciprofloxacin, can make people more prone to rupture. Patients who have experienced a ruptured Achilles tendon often complain of a “popping” sensation followed by sudden, severe pain.

After an Achilles tendon rupture, all patients should acutely rest the joint, ice the area, elevate the ankle, and take analgesics, like acetaminophen, to decrease their pain. From that point, patients have a variety of treatment options. Choosing the right treatment option depends on the patient’s lifestyle and health goals. Treatment is organized into two categories: non-operative vs. operative management.

Non-Operative Treatment

Non-operative treatment refers to management that does not involve surgery. Beyond the management methods mentioned above, non-operative management includes a CAM boot for six to eight weeks. This method immobilizes the joint and allows the tendon to heal on its own. Afterward, the orthopedic surgeon may recommend physical therapy to help strengthen the tendon and the surrounding muscles. We follow a specific protocol as listed below.

The non-operative option is not for everyone. It is ideal for people who often are older, who would like to avoid surgery, and do not participate in athletic or strenuous activities. Some surgeons believe that Achilles tendon ruptures that are managed non-operatively are more likely to re-rupture.

Follow the nonoperative protocol here to learn more.

Operative

Surgical options are better suited for those who are younger, more active, and have less aversion to surgery. A repair allows the surgeon to visualize the tendon and bring the two edges of edges of tendon back together and sew together with suture. Surgical management decreases the rate of re-rupture, making it a better option for people who anticipate leading an active lifestyle.

When choosing either non-operative or operative management, it is important to consult an orthopedic surgeon. He or she can help decide which treatment option is most appropriate.

Summary

The Achilles tendon is an important part of the ankle, connecting the calf muscles to the bones of the foot. The tendon facilitates flexion of the foot, allowing running, jumping, and many other motions of everyday life. An Achilles tendon rupture can happen to different people for a variety of reasons. Treatment can be non-operative or operative and depends on the goals of the patient. An orthopedic surgeon is the physician best able to answer questions about the right treatment for each patient. Ask Dr. Morton about your options in regard to Achilles tendon rupture.

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