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Achilles Tendon Rupture
Dr Kau Chung Yuan (许医生)
MBBS (S’PORE)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
What is an Achilles Tendon Rupture?
Achilles tendon rupture refers to a complete or partial tear of the Achilles tendon, a strong fibrous cord located at the back of the lower leg.
This tendon, the largest in the human body, plays a crucial role in facilitating movements such as walking, running, and jumping by connecting the calf muscles to the heel bone.
Causes
Achilles tendon rupture is linked to a sudden increase in stress on the tendon. Key factors include:
- Overuse and Strain
Intense or prolonged physical activities, especially in sports, can put excessive strain on the Achilles tendon. Sudden changes in activity level, such as rapidly increasing the intensity or duration of exercise, are particularly risky. - Age-Related Factors
As people age, the Achilles tendon loses flexibility and is more prone to injury. - Medical Conditions and Medications
Certain medical conditions, like flat feet, can alter normal walking patterns and place additional stress on the tendon. Some medications, such as corticosteroids and certain types of antibiotics, may weaken the tendon and increase the risk of rupture. - Trauma
Direct trauma to the ankle or lower leg, such as a sharp impact or severe twist, can cause an immediate rupture of the tendon.
Symptoms
The symptoms of an Achilles tendon rupture can vary depending on the severity of the injury but typically include the following key indicators:
- Sudden and Severe Pain
The most immediate symptom is a sharp pain in the back of the ankle or lower leg, often described as feeling like being kicked or hit in the area. - Audible Pop or Snap
Some people may hear a popping or snapping sound at the moment of injury. - Swelling and Bruising
The area around the Achilles tendon can become swollen and, in some cases, bruised. - Difficulty Walking
Those with a ruptured Achilles tendon may find it challenging to walk, especially when trying to push off the affected foot or stand on tiptoes. - A Gap in the Tendon
In severe cases, a noticeable gap can be felt in the tendon just above the heel.
Diagnosis
Diagnosing an Achilles tendon rupture typically involves a combination of clinical examination and imaging tests. The process usually includes:
Physical Examination
The surgeon will examine the affected leg for tenderness, swelling, and a possible gap in the tendon. They may also perform the Thompson test, where the patient lies face down and the surgeon squeezes the calf muscle. A lack of movement of the foot indicates a possible rupture.
Medical History Review
Understanding the patient’s recent activities and any history of leg pain or injuries can aid in diagnosis.
Imaging Tests
- Ultrasound: This test can visualise the soft tissues and show whether the tendon is intact.
- Magnetic Resonance Imaging (MRI): Although not always required, an MRI provides a detailed view of the Achilles tendon and can help determine the extent of the rupture.
Non-Surgical Treatment Options
Non-surgical treatment may be recommended for Achilles tendon rupture, especially in cases of partial tears, in less active people, or where surgery poses higher risks. The options include:
- Immobilisation
The foot is kept immobilised in a cast, brace, or walking boot to allow the tendon to heal naturally. The position typically involves pointing the toes downward to reduce tension on the Achilles tendon. - Physical Therapy
Once the initial healing phase is complete, physical therapy plays a vital role in restoring strength and flexibility to the tendon and calf muscles. - Activity Modification
Temporarily modifying activities to reduce strain on the Achilles tendon during the recovery phase. - Pain Management
Over-the-counter pain relief medications can be used to manage discomfort during the healing process.
Surgical Treatment Options
Surgery is often recommended for active people or in cases of complete Achilles tendon ruptures. The choice of surgical method depends on various factors, including the specific nature of the rupture, the patient’s overall health, and their lifestyle needs.
Open Surgery
This traditional method involves making an incision in the back of the lower leg and stitching the torn tendon together. While effective, open surgery carries a higher risk of wound complications and infection.
Minimally Invasive Surgery
These procedures use smaller incisions, resulting in less tissue damage and potentially quicker recovery times. Techniques vary, including percutaneous methods where sutures are passed through small incisions.
Dr. Kau Chung Yuan
MBBS (S’pore)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
Dr Kau (许医生) is a Fellowship trained Orthopaedic Surgeon with a subspecialty interest in Hip and Knee surgery and has been in practice for more than 15 years.
He is experienced in trauma and fracture management, sports injuries, and joint replacement surgery.
- Fellow of the Royal College of Surgeons Edinburgh, Orthopaedics (FRCS, Edin) 2014
- Master of Medicine (Orthopaedics), Singapore (MMed) 2013
- Member of the Royal College of Surgeons Ireland (MRCS, Ire) 2009
- Bachelor of Medicine and Surgery (MBBS, Singapore) 2004
Prevention Strategies
While it may not be possible to completely prevent an Achilles tendon rupture, strategies can reduce the risk. These include:
- Regular Stretching and Strengthening: Maintaining flexibility and strength in the calf muscles can help alleviate stress on the Achilles tendon. Stretching exercises are particularly important for those who engage in regular physical activity.
- Gradual Increase in Activity: Avoid sudden increases in the intensity or duration of exercise. Gradually building up the level of activity allows the tendon to adapt and strengthen.
- Appropriate Footwear: Wearing shoes that provide proper support and cushioning can help protect the Achilles tendon, especially during high-impact activities.
- Cross-Training: Engaging in a variety of exercises reduces the constant strain on the Achilles tendon and improves overall leg strength and flexibility.
- Heed Warning Signs: Paying attention to symptoms like pain or stiffness in the Achilles tendon area can help take early action and prevent a rupture.
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Frequently Asked Questions (FAQs)
How Long is the Recovery Period After an Achilles Tendon Rupture?
Recovery varies, with non-surgical recovery typically taking 6-12 months and surgical recovery 4-6 months. Depending on rehabilitation adherence, a full return to sports or high-impact activities can take up to a year.
How Can I Strengthen My Achilles Tendon?
Strengthening exercises like calf raises and eccentric heel drops are effective. Regular stretching and flexibility exercises can also reduce the risk of future injuries.
Is It Possible to Fully Recover from an Achilles Tendon Rupture?
Most people can fully recover from an Achilles tendon rupture with appropriate treatment and a structured rehabilitation program. The extent of recovery is influenced by the severity of the injury, the treatment method, and patient adherence to rehabilitation protocols.