Overview The Achilles tendon is the largest and strongest tendon in the body. It functions to help control the foot when walking and running. Ruptures of the Achilles tendon commonly occur in individuals in their 30s and 40s. This age group is affected because these patients are still quite active, but over time their tendons tend to become stiffer and gradually weaken. These ruptures usually occur when an athlete loads the Achilles in preparation to pushing off. This can occur when suddenly changing directions, starting to run, or preparing to jump. These ruptures occur because the calf muscle generates tremendous force through the Achilles tendon in the process of propelling the body. Patients will feel a sharp intense pain in the back of their heel. Patients often initially think that they were ?struck in the back of the heel? and then realize that there was no one around them. After the injury, patients will have some swelling. If they can walk at all, it will be with a marked limp. It is very rare that a rupture of the Achilles is partial. However, a painful Achilles tendonitis or a partial rupture of the calf muscle (gastrocnemius) as it inserts into the Achilles can also cause pain in this area. The pain of an Achilles rupture can subside quickly and this injury may be misdiagnosed in the Emergency Department as a sprain. Important clues to the diagnosis are an inability to push off with the foot and a visible or palpable defect just above the heel bone in the back of the leg. Causes The Achilles tendon is a strong bands of fibrous connective tissue that attaches the calf muscle to the heel bone. When the muscle contracts, the tendon transmits the power of this contraction to the heel bone, producing movement. The Achilles tendon ruptures because the load applied to it is greater than the tendon's ability to withstand that load. This usually occurs as a result of a sudden, quick movement where there is a forceful stretch of the tendon or a contraction of the muscles eg: jumping, sprinting, or pushing off to serve in tennis. This occurs most often in sports that require a lot of stopping and starting (acceleration-deceleration sports) such as tennis, basketball, netball and squash. The Achilles tendon is on average 15cm in length. Most ruptures occur 2-6cm above where the tendon inserts into the heel bone. This is the narrowest portion of the Achilles tendon and is also the area with the poorest blood supply. achilles tendon rupture is most common when the muscles and tendon have not been adequately stretched and warmed up prior to exercise, or when the muscles are fatigued. the Achilles tendon has a poor blood supply, which makes it susceptible to injury and slow to heal after injury. During exercise the amount of blood able to travel to the tendon is decreased, further increasing the risk of rupture. Most experts agree that there are no warning signs of an impending rupture. However, frequent episodes of Achilles tendonitis (tendon inflammation) can weaken the tendon and make it more susceptible to rupture. Symptoms Following are a few of the symptoms usually associated with an Achilles tendon rupture. Sudden, severe pain, swelling, bruising, difficulty walking. Sometimes a gap may be felt in the tendon. The most common ways an Achilles tendon rupture is diagnosed are clinical history (presenting symptoms). Thompson or Simmonds? test, positive if when squeezing the calf there is no foot movement (passive planter flextion). O?Brien?s test, needles are placed into the tendon; tendon is intact if when the foot is moved up and down, the needle hub moves in the same direction as the toes (opposite direction of the tendon) Ultrasound and MRI, because these technologies involve an added expense, they are usually employed only to confirm the diagnosis. Diagnosis The actual area of an Achilles tendon rupture cannot be seen on x-ray. Therefore, although x-rays are often done to rule out bony injuries in individuals with an Achilles tendon rupture these x-rays are usually normal. Diagnostic ultrasound of the tendon can be performed to assess the integrity of the tendon. Other diagnostic tests, such as MRI's, may also be required in difficult cases. Non Surgical Treatment Your doctor may advise you to rest your leg and keep the tendon immobile in a plaster cast while it heals. Or you may need to have an operation to treat an Achilles tendon rupture. The treatment you have will depend on your individual circumstances, such as your age, general health and how active you are. It will also depend on whether you have partially or completely torn your tendon. If you have a partial tear, it might get better without any treatment. Ask your doctor for advice on the best treatment for you. If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice. Surgical Treatment The surgical repair of an acute or chronic rupture of the Achilles tendon typically occurs in an outpatient setting. This means the patient has surgery and goes home the same day. Numbing medicine is often placed into the leg around the nerves to help decrease pain after surgery. This is called a nerve block. Patients are then put to sleep and placed in a position that allows the surgeon access to the ruptured tendon. Repair of an acute rupture often takes somewhere between 30 minutes and one hour. Repair of a chronic rupture can take longer depending on the steps needed to fix the tendon.