According to statistics, most Achilles tendon ruptures are 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 heel bone is completely or partially torn.
With this damage, you can feel a click or crackle, after which there is a sharp pain in the lower leg and back of the ankle. An injury almost always prevents normal walking, and many doctors recommend surgery as the most effective treatment for a tear. However, more conservative approaches can also work.
Symptoms
Although Achilles tendonitis and subsequent rupture may be asymptomatic, most people notice one or more signs of damage:
- pain (often severe and accompanied by swelling in the ankle area);
- inability to bend the foot downward or push off the ground with the affected leg while walking;
- not being able to stand on the endsfingers on the injured leg;
- clicking sound or crackling sound at the time of tendon rupture.
Even if there is no pain as such, you should seek medical advice immediately after you hear a click or crack in the heel, especially if you lose the ability to walk normally immediately after this sound.
Reasons
Achilles tendon helps to lower the moving part of the foot down, rise on tiptoe and push off the foot from the ground when walking. It gets activated in one way or another every time you move your foot.
Tear usually occurs at an area six centimeters above the junction of the tendon with the calcaneus. This area is especially vulnerable, as blood circulation is difficult here. For the same reason, the tendon heals very slowly after injury.
Very common examples of Achilles tendon ruptures caused by a sharp increase in load are known:
- increase the intensity of sports, especially if they include jumping;
- falling from a height;
- feet falling into a hole.
Risk factors
Some circumstances increase the risk of Achilles tendon ruptures:
- Age. Most often, injuries of this type are observed in patients from thirty to forty years old.
- Gender. According to statistics, for every female patient, there are five men with a tendon rupture.
- Sports. Most oftendamage is caused by physical activity, including running, jumping and alternating sudden movements and stops. Football, basketball, tennis are examples.
- Injections of steroids. Doctors sometimes prescribe steroid injections into the ankle joint to reduce pain and relieve inflammation. However, these substances can weaken nearby tendons and eventually lead to ruptures.
- Taking some antibiotics. Fluoroquinolones such as Ciprofloxacin or Levofloxacin increase the risk of injury in everyday activities.
Before visiting the doctor
Given that a tear (as well as inflammation) of the Achilles tendon can lead to the inability to walk normally, you should immediately seek medical help. Additional visits to a sports medicine or orthopedic doctor may be required.
To make the consultation as effective as possible, just before the appointment, write down the following information on paper:
- detailed description of the symptomatology and the previous traumatic event;
- information about past he alth problems;
- list of all medications and supplements taken;
- questions you would like to ask your doctor.
What will the doctor say?
An expert will likely ask you the following questions:
- How did the tendon injury happen?
- Did you hear (or perhaps not hear, but feel) a click or crack when you get injured?
- Can you stand on your toes on your injured leg?
Diagnosis
During the initial medical examination, the doctor will examine the lower leg for tenderness and swelling. In many cases, a specialist can manually feel for a rupture in the tendon if it has torn completely.
Your doctor may ask you to kneel in a chair or lie on your stomach on the examination table with your feet hanging over the edge of the table. With this diagnostic method, the doctor squeezes the patient's calf muscle to check the reflex: the foot should automatically bend. If it remains motionless, it is likely that the Achilles tendon has become inflamed. This is what ultimately led to the injury.
If there is a question about the extent of the damage (that is, whether the tendon is completely torn or only partially), the doctor will prescribe an ultrasound or magnetic resonance imaging. Thanks to these painless procedures, detailed images of any tissues and organs in the body can be taken.
Treatment
Many people injure their Achilles tendons to some extent. 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 surgery, this is the most effective method. Patients of older age groups tend to conservative treatment more often. According to recent studies, it is correctprescribed conservative therapy may be as effective as surgery.
Treatment without surgery
In this approach, patients usually wear special orthopedic shoes with a platform under the heel - this allows the torn tendon to heal on its own. This method eliminates many operational risks, such as infection. However, recovery while wearing orthopedic shoes takes much longer than treating an injury with surgery, and there is a high risk of re-rupture. 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 repair the Achilles tendon rupture.
Operation
Usually, surgery is as follows. The doctor makes an incision in the back of the leg and stitches the torn parts of the tendon together. Depending on the condition of the damaged tissue, it may be necessary to reinforce the sutures with other tendons. Possible complications after surgery include infections and nerve damage. The risk of infection is greatly reduced if the surgeon makes small incisions during the operation.
Contraindications
Surgical treatment of Achilles tendon ruptures is contraindicated in those diagnosed with an active infection or skin disease in the area of injury. Conservative therapy is also prescribed for patients with general poor he alth, diabetes, smoking addiction. are contraindications andcircumstances such as sedentary lifestyle, steroid use, and inability to follow the surgeon's postoperative instructions. Any he alth concerns should be discussed with your doctor first.
Rehab
To permanently heal a torn Achilles tendon (after surgery or conservative therapy - it doesn't matter), you will be assigned a rehabilitation program that includes physical exercises to train the muscles of the legs and Achilles tendon. Most patients return to their normal lifestyle four to six months after the end of therapy or surgery.
Exercise
After conservative treatment, rehabilitation exercises can be started 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 the injury is an Achilles tendon rupture). Rehabilitation begins with massage and increasing the overall mobility of the ankle - the feeling of stiffness should disappear. After two weeks of gentle therapy, active exercise is prescribed, and the best results can be achieved if you shine the much-needed physical activity from 12 to 16 weeks. The load begins with stretching, then they move on to strength exercises, including bending and straightening the knee.
If the pain syndrome is completely gone, you can connect a more sports-oriented load to training. It is desirable for athletes to go jogging and make more jumps. Recurrent Achilles tendinitis and subsequent rupture will become much less likely if the patient adheres carefully to the prescribed rehabilitation measures.
