A total rupture of the Achilles tendon is a complete tear of the tendon and typically affects men over the age of 40 involved in recreational sport.
It is not always recognized at the time of injury, however it is very important it is treated properly as soon as possible to increase the chances of a good recovery.
Symptoms include a sudden sharp pain in the Achilles tendon which is often described as if being physically struck by an object or implement. A loud snapping noise or bang may also be heard at the time. A gap of 4 to 5 cm in the tendon can be felt immediately after injury which may be less obvious later as swelling increases. There will be considerable loss of function and the patient will most likely be limping, however they may still be quite capable of walking or even playing on due to other muscles compensating.
There are four key tests to help diagnose a complete rupture of the Achilles tendon:
1. With the patient lying face down with their feet hanging over the edge of a table or therapy couch, the foot of the injured side will hang directly down, compared to the non injured one would be slightly pointed (plantar flexed).
2. Is there a gap of approximately 3 to 6 cm in the Achilles tendon directly after injury? If there is too much swelling then this is not always obvious.
3. Plantar flexion strength is significantly reduced. For example the patient will be unable to point their foot downwards against resistance or go up on top toes.
4. Thompson's squeeze test will give a positive result
Thompsons test is performed by squeezing the calf muscles at the belly of the muscle. In a healthy ankle the foot should move. If there has been a complete rupture of the Achilles tendon then the foot will not move as expected. Sometimes is can be difficult to tell if there has been a complete rupture of the Achilles tendon just by looking or level of pain.
The Achilles tendon runs from the calf muscles at the back of the lower leg and inserts at the back of the heel or calcaneus bone. Large forces are transmitted through the tendon when running and jumping. The tendon itself is surrounded by a thin sheath.
A torn achilles can be a partial rupture or a total rupture. A total rupture is more common in men affecting them 10 times more than women. Injury typically occurs 30 to 40 minutes into a period of exercise rather than at the start of a session and nearly always happens from a sudden explosive movement or bending the foot upwards (known as dorsi flexing).
Many patients are able to continue to function following an Achilles rupture due to other muscles compensating, although the injured leg will be significantly weaker.
If a total rupture of the Achilles tendon is suspected then apply cold therapy and compression and seek medical attention as soon as possible. In most cases surgery is required and the sooner this takes place the higher the chances of success. If the injury is left longer than two days then the chances of a successful outcome may decrease. Sometimes the leg is put in a cast and allowed to heal without surgery. A full rehabilitation program is necessary following surgery with the patient being out of competition for between 6 and 12 months.
Read more on treatment and rehabilitation....