Achilles tendon rupture

Subject: Achilles tendon rupture Tue Dec 28, 2010 8:56 pm

Achilles (uh-KIL-eez) tendon rupture is an injury that affects the back of your lower leg. It most commonly occurs in people playing recreational sports.

The Achilles tendon is a strong fibrous cord that connects the muscles in the back of your calf to your heel bone. If you overstretch your Achilles tendon, it can tear (rupture). An Achilles tendon rupture can be partial or complete.

If you have an Achilles tendon rupture, you might feel a pop or snap, followed by an immediate sharp pain in the back of your ankle and lower leg that makes it impossible to walk properly. It almost feels like you've been kicked, or even shot.

Surgery is often the best treatment option to repair an Achilles tendon rupture.

Symptoms
Signs and symptoms of an Achilles tendon rupture include:

Pain, possibly severe, and swelling near your heel
An inability to bend your foot downward or "push off" the injured leg when you walk
An inability to stand up on your toes on the injured leg
Often people report hearing a popping or snapping sound when the injury occurs. With a partial rupture, you may still be able to move your foot, and you may experience less severe pain and swelling.

When to see your doctor
Seek medical advice immediately if you feel a pop or snap in your heel, especially if you can't walk properly afterward. An Achilles tendon rupture requires prompt treatment.

Causes
Your Achilles tendon helps you point your foot downward, rise on your toes and push off your foot as you walk. You rely on it virtually every time you move your foot.

In most cases, ruptures of the Achilles tendon occur at a spot on the tendon that receives less blood flow. This may weaken that section of the tendon, which also tends to degenerate with age.

Ruptures often are caused by a sudden increase in the amount of stress on your Achilles tendon. Common examples include:

Occasional or increased participation in recreational sports
Falling from a height
Stepping into a hole

Risk factors
Factors than may increase your risk of Achilles tendon rupture include:

Age. The peak age for Achilles tendon rupture is 30 to 40.
Sex. Achilles tendon rupture is up to five times more likely to occur in men than in women.
Obesity. Extra pounds may increase the stress placed on your Achilles tendon.
Recreational sports
Achilles tendon injuries occur more often in sports that involve running, jumping and sudden starts and stops. Examples include:

Running
Soccer
Basketball
Tennis
Softball
Hockey

Preparing for your appointment
Because an Achilles tendon rupture often can impair a person's ability to walk, it's common to seek immediate treatment at a hospital's emergency department.

What you can do
You may want to write a list that includes:

Detailed descriptions of the symptoms and the precipitating event
Information about past medical problems
All the medications and dietary supplements you take
Questions you want to ask the doctor
What to expect from your doctor
During the physical exam, your doctor will inspect your lower leg for tenderness and swelling. In many cases, doctors can feel a gap in your tendon if a complete rupture has occurred. This may be obscured by swelling, however.

The doctor may also ask you to kneel on a chair or lie on your stomach with your feet hanging over the end of the exam table. He or she may then squeeze your calf muscle to see if your foot will automatically flex. If it doesn't, you probably have ruptured your Achilles tendon.

Tests and diagnosis
If there's a question about a partial or complete rupture of your Achilles tendon, your doctor may order a magnetic resonance imaging (MRI) scan, a painless procedure that uses radio waves and a strong magnetic field to create a computerized image of the tissues of your body.

Treatments and drugs
Surgery
Surgery is a common treatment for a complete rupture of the Achilles tendon. The procedure generally involves making an incision in the back of your lower leg and stitching the torn tendon together. Depending on the condition of the torn tissue, the repair may be reinforced with other tendons. Afterward, you'll need to spend about six to eight weeks with your leg in a walking boot, cast, brace or splint.

Nonsurgical treatment
This approach typically involves wearing a cast or walking boot, which allows the ends of your torn tendon to reattach themselves on their own. This method can be effective, and it avoids the risks, such as infection, associated with surgery. However, the likelihood of re-rupture is higher with a nonsurgical approach, and recovery can take longer. If re-rupture occurs, surgical repair may be more difficult.

Rehabilitation
After treatment, whether surgical or nonsurgical, you'll go through a rehabilitation program involving physical therapy exercises to strengthen your leg muscles and Achilles tendon. Most people return to their former level of activity within four to six months.

Prevention
To help prevent an Achilles tendon injury, gently stretch your Achilles tendon and calf muscles before taking part in physical activities. Perform stretching exercises slowly, stretching to the point at which you feel a noticeable pull, but not pain. Don't bounce during a stretch. To help the muscle and tendon absorb more force and avoid injury, try exercises that strengthen your calves.

To further reduce your chance of developing Achilles tendon problems, follow these tips:

Avoid activities that place excessive stress on your Achilles tendons, such as hill-running and jumping activities.
If you notice pain during exercise, rest.
If one exercise or activity causes you persistent pain, try another.
Alternate high-impact sports, such as running, with low-impact sports, such as walking, biking or swimming.
Maintain a healthy weight.
Wear well-fitting athletic shoes with proper cushioning in the heels.