An Achilles tendon tear is a complete rupture or partial tear in the tendon running along the back of the lower leg that connects the calf muscles to the heel bone (calcaneus). Partial and full tears are most likely the result of activities that involve forceful bursts of jumping, pivoting, or running. The injury commonly occurs in individuals playing recreational sports. A tear can also be the result of direct trauma to the Achilles tendon as occurs in an accident or fall. The Achilles tendon may grow weak with age or prolonged inactivity and become even more susceptible to injury or rupture.
The Achilles tendon is the thickest and strongest tendon in the human body. A tough band of fibrous tissue, it is also known as the calcaneal tendon or heel cord. The Achilles tendon is formed as the gastrocnemius and soleus muscles (calf muscles) unite into one band of tissue at the low end of the calf. Its terminal insertion is at the back of the heel bone and is cushioned by fluid filled sacs known as bursae. Although the Achilles tendon has an extraordinary ability to withstand great stress from running, jumping, and all of the daily activities, it is also prone to injury from overuse, degeneration, and trauma.
The Achilles tendon has a massive job to do. As the calf muscles contract, the heel by way of this tendon, is lifted. This action allows one to point their foot and stand on tiptoe. It also produces the majority of force that allows the foot to push down, which is an essential component of every step whether it be for walking, running, jumping or any other related movement.
Although the Achilles tendon is quite strong, due to a limited blood supply and the massive demands placed on the tendon, it is susceptible to injury. When the Achilles tendon stretches beyond its biomechanical limits, it may tear. Most cases of involving a tear are the result of a sports activity. It is an especially common injury in middle–aged “weekend warriors” who participate in sports during their spare time. Older individuals, as well as those with a history of previous Achilles tendon injuries, certain illnesses, or taking certain medications, may have a weakened tendon and have a higher risk of suffering a tear.
Achilles tendon tears can range from micro-tears, with or without symptoms, to larger ruptures that cause significant pain, swelling and impairment. Additionally, a tear may occur suddenly or develop gradually over time.
Symptoms of a complete tear or total rupture may include:
- Immediate acute pain often described as being struck by sharp object in the Achilles area
- A snap or pop at the time of injury
- Difficulty walking and rising up on the toes
- Swelling on the back of the lower leg
In cases of a partial tear the symptoms may vary. The amount of tenderness, swelling, pain, stiffness and the degree of impairment depends on the severity of the tear.
Diagnosing a torn Achilles tendon begins with a thorough medical history and the performance of a physical exam. During the clinical examination the doctor will examine the foot, ankle, and calf, to check for signs of an Achilles tendon injury. Range of motion, the ability to perform certain movements, and muscle strength will be evaluated. Imaging tests may be also ordered to fully assess the damage.
Treatment depends on the severity of the rupture as well as an individual’s health and activity level. Options include both surgical and non-surgical approaches. For minor ruptures and for individuals who have medical conditions that preclude surgery, a non-surgical treatment may be suggested. In instances of a complete tear of the tendon, surgery is typically recommended.