Overview An Achilles tendon rupture is when you tear the tissue that connects your calf muscle to your heel bone. Your Achilles tendon is very strong and flexible. It?s at the back of your ankle and connects your calf muscle to the bone in the heel of your foot (calcaneum). If you rupture your Achilles tendon, you can either partially or completely tear the tendon. Most people who injure their Achilles tendon are between 30 and 50 and don?t exercise regularly. It?s more common in men but can affect anyone. It happens most often in the left leg. This may be because most people are right-handed which means that they ?push off? more frequently with the left foot when running. Causes Often an Achilles rupture can occur spontaneously without any prodromal symptoms. Unfortunately the first "pop" or "snap" that you experience is your Achilles tendon rupture. Achilles tendon rupture most commonly occurs in the middle-aged male athlete (the weekend warrior who is engaging in a pickup game of basketball, for example). Injury often occurs during recreational sports that require bursts of jumping, pivoting, and running. Most often these are tennis, racquetball, squash, basketball, soccer, softball and badminton. Achilles rupture can happen in the following situations. You make a forceful push-off with your foot while your knee is straightened by the powerful thigh muscles. One example might be starting a foot race or jumping. You suddenly trip or stumble, and your foot is thrust in front to break a fall, forcefully over stretching the tendon. You fall from a significant height. It does appear that previous history of Achilles tendonitis results in a degenerative tendon, which can grow weak and thin with age and lack of use. Then it becomes prone to injury or rupture. Certain illnesses (such as arthritis and diabetes) and medications (such as corticosteroids and some antibiotics) can also increase the risk of rupture. Symptoms If you rupture your Achilles tendon, you may hear a snapping or popping sound when it happens. You will feel a sudden and sharp pain in your heel or calf (lower leg). It might feel like you have been kicked or hit in the back of your leg. You may also have swelling in your calf. be unable to put your full weight on your ankle, be unable to stand on tiptoe, or climb stairs, have bruising around the area. If you have any of these symptoms and believe you have ruptured your Achilles tendon, go straight to accident and emergency at your local hospital. If you partially rupture your Achilles tendon, the tear may only be small. Symptoms of pain and stiffness may come on quite suddenly like a complete rupture, but may settle over a few days. Diagnosis A physician usually can make this diagnosis with a good physical examination and history. X-rays usually are not taken. A simple test of squeezing the calf muscles while lying on your stomach should indicate if the tendon is still connected (the foot should point). This test isolates the connection between the calf muscle and tendon and eliminates other tendons that may still allow weak movement. A word of caution, Achilles tendon rupture is often misdiagnosed as a strain or minor tendon injury. Swelling and the continuing ability to weakly point your toes can confuse the diagnosis. Ultrasound and MRI are tests that can assist in difficult diagnosis. Depending on the degree of injury, these tests can also assist in determining which treatment may be best. Non Surgical Treatment Treatment of a ruptured Achilles tendon is usually conservative (non-operative) in a Controlled Motion Ankle (CAM) Boot or it may require surgery. The current consensus based on research is to treat them conservatively since the functional outcome and chance of re-rupture is similar (7% to 15%) using both approaches but surgical intervention has a higher risk of infection. Achilles tendon surgery is usually considered if your Achilles has re-ruptured or there is delay of two weeks between the rupture and the diagnosis and commencement of conservative bracing and treatment. Surgical Treatment In general, for complete tear of the tendon, surgery is recommended. For partial tears, nonsurgical treatment is recommended. However, the selection of treatment depends on the patient, age, level of activity, and other risk factors. Surgery for Achilles tendon rupture is now routine and well established. Surgery is generally suggested for the young, healthy and active individuals. For athletes, surgery is often the first choice of treatment. The Achilles tendon can be repaired surgically by either a closed or open technique. With the open technique, an incision is made to allow for better visualization and approximation of the tendon. With the closed technique, the surgeon makes several small skin incisions through which the tendon is repaired. Irrespective of type of treatment, a short leg cast (plaster) is applied on the operated ankle after completion of the procedure. The advantages of a surgical approach includes a decreased risk of re-rupture rate (0%-5%) the majority of individuals can return to their original sporting activities (within a short time), and most regain their strength and endurance. Disadvantages of a surgical approach include hospital admission, wound complications (for example, skin sloughing, infection, sinus tract formation, sural nerve injury), higher costs, and hospital admission.