Achilles Tendon Rupture

Achilles Tendon Rupture/Tear

The Achilles tendon is the thickest and strongest tendon in the body. This long band of tissue attaches the muscles of the calf to the heel bone and is responsible for allowing the foot to flex. The Achilles tendon enables the athlete to push off of the foot when walking or jumping. Spontaneous rupture of the Achilles tendon usually occurs in men between the ages of thirty and fifty years of age who participate in recreational sports activities. This injury has also been reported in professional baseball players like Eduardo Perez of the Tampa Bay Devil Rays, and in football players like former New York Jets quarterback, Vinny Testaverde. 

There can be a number of factors that cause the tendon to tear. Patients who have taken steroids for a long time tend to have weakened connective tissue which is more susceptible to rupture. Another common cause of Achilles tendon tears is related to a problem called tendinosis. This is a overuse phenomenon that is the result of accumulative impact loading and repetitive micro-trauma to the tendon. With this condition, the tendon is not as strong in any one part of its length as it should be, and repetitive activity causes the tendon to partially tear and eventually fail.

In the professional arena, most Achilles injuries seem to occur in the quick acceleration/jumping-type sports like basketball, baseball or football. In a number of ruptures of the stop-and-start variety or the backward-to-foward transition, the tendon has a heavy load applied to followed quickly by a sudden change in direction. Think of a quaterback dropping back to pass and then stepping up into the pocket, or a baseball player that attempts to steal a base and then is forced to change directions immediately to avoid being tagged out.

Typically, the tendon ruptures approximately four to six centimeters up from where it attaches to the heel bone. This area has been shown to have a diminished amount of blood supply and may predispose the tendon to mechanical failure due to poor healing potential. The patient will usually relate that it feels that someone on something has hit them in the calf. Occasionally, it may feel like something has popped, along with associated swelling, pain and weakness when walking. An examiner can perform what is called the Thompson's test if they suspect Achilles tendon damage. The patient lies face down on a table and the physician squeezes the calf muscle. If the tendon is intact, the foot will point towards the ceiling, which shows tendon integrity and means that there is not a complete tear. However, if you squeeze the calf and the foot remains motionless, this signals that the tendon is completely ruptured.

Most healthy athletes will recover predictably when their Achilles tendon is repaired surgically and then aggressively rehabilitated. The two ends of the tendon are sewn together and the foot and lower leg are placed in a cast with the foot pointed down to lessen the tension on the repaired tendon. In older, less active individuals, a non-operative approach may be employed, whoch involves cast immobilization for a long period of time. Regardless of the treatment, athletes can expect a six to twelve recovery period. This is usually a season-ending injury because complete healing needs to take place to avoid the possibility of re-rupturing the tendon.

To minimize the chance of injuring the Achilles tendon, one should practice proper stretching before beginning an activity. Loosen up by doing gentle calf stretches. This is especially true if you are older or not well-conditioned. Finally, be aware of any pain in the Achilles tendon and make sure to treat any sign of calf pain with rest, ice and elevation.

Author
Luis M. Espinoza MD Dr. Espinoza served as the AAA Team Doctor for the the New Orleans Zephyrs/BabyCakes since joining the Orthopedic Center for Sports Medicine in 2003. He is double board certified in General Orthopedic Surgery and Sports Medicine.

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