Achilles Tendon Tear

Condition Basics

What is an Achilles tendon tear?

An Achilles tendon tear—sometimes called a rupture—can be partial or complete. Partial tears may cause no symptoms. But complete tears cause pain and sudden loss of strength and movement. Middle-aged adults doing sports activities are more likely to get this kind of injury. Tears also happen in older adults.

What causes it?

An Achilles tendon tear is most often caused by a sudden, forceful motion that stresses the calf muscle. This can happen during an intense sports activity or even when you just run or jump. Middle-aged adults are more likely to get this kind of injury.

What are the symptoms?

Symptoms of an Achilles tendon tear may include a sudden, sharp pain. Most people feel or hear a pop. You may have swelling and bruising. You may not be able to point your foot down or stand on your toes. Some people with partial tears may not have any symptoms.

How is it diagnosed?

Most doctors diagnose an Achilles tendon problem by asking questions about your past health and checking the back of your leg for pain and swelling. If your symptoms are severe or don't improve with treatment, your doctor may want you to get an X-ray, an ultrasound, or an MRI.

How is an Achilles tendon tear treated?

Surgery may be used to treat a torn tendon. A cast, splint, brace, walking boot, or other device may also be used. These devices keep the lower leg and ankle from moving. Rehab follows both of these treatments. Exercise, in either physical therapy or a rehab program, can also be used.

Cause

An Achilles tendon tear is most often caused by:

Sudden, forceful motion that stresses the calf muscle.

This can happen during an intense sports activity. It can even happen during simple running or jumping. (This is more common in middle-aged adults.) A tear most often occurs in sports such as basketball, racquet sports (like tennis), soccer, and softball.

Overstretching the tendon.

You may overstretch your tendon and cause a tear during any activity when the tendon is already damaged. The damage could be caused by Achilles tendinopathy. Or it could be caused by another condition.

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What Increases Your Risk

Things that increase your risk for an Achilles tendon tear include:

Sports and physical activity.

Overuse and repeated movements can weaken the tendon. Playing sports and doing activities at work and at home can raise your risk.

Sports training errors.

These include:

• Suddenly changing your training program.
• Changing your ground surfaces or increasing your distance too quickly.
• Running uphill more often than before.

Age.

Most Achilles tears occur in people older than 30.

Weight.

People who are very heavy have a greater risk.

Being male.

Men are more likely than women to have an Achilles tendon injury.

Footwear.

Wearing shoes that don't support your feet or cushion your heel can increase your risk.

Certain diseases or injuries.

• A past Achilles tendon injury, osteoarthritis, gout, or rheumatoid arthritis are risk factors.

Some medicines.

• Corticosteroid injections in the Achilles tendon can weaken it.
• Fluoroquinolone antibiotics may make a tear more likely.

Symptoms

Symptoms of an Achilles tendon tear may include:

• A sudden, sharp pain that feels like a direct hit to the Achilles tendon. There may be a pop when the tear occurs. This may be followed by swelling and bruising.
• Heel pain. (It may be severe.)
• Not being able to go on tiptoe with the hurt leg.

If you have only a partial tear of the Achilles tendon, you may have near-normal strength after the injury. Some people with partial tears may not have any symptoms.

What Happens

An Achilles tendon can partially or completely tear. A tear usually occurs in the lower part of the tendon. Some doctors believe that this area is most likely to tear because of a limited blood supply.

If you don't treat a badly torn Achilles tendon, your tendon may heal with time. But your leg may not be as strong as if the tear had been treated.

When to Call a Doctor

Call your doctor now if you think you have an Achilles tendon problem (at or above the back of your ankle) and:

• The back of your heel and ankle are very painful.
• You felt a sharp pain like a direct hit to the Achilles tendon.
• You heard a pop in your Achilles tendon when you were injured.
• You aren't able to walk comfortably.
• Your Achilles tendon area has begun to swell.
• You have signs of damage to the nerves or blood vessels. Signs include numbness, tingling, a pins-and-needles feeling in your foot, and pale or bluish skin.

If you had an Achilles tendon injury in the past and you have reinjured your Achilles tendon, call your doctor to find out what you need to do. Rest your lower leg and foot until treatment begins.

Watchful waiting

Watchful waiting is a wait-and-see approach. It's not a good choice if you have severe pain in the Achilles tendon area. Early treatment works best.

If you think you have Achilles tendinopathy and you have mild symptoms, rest your lower leg and foot for a couple of days. If you have weakness, cramping, or constant pain in your Achilles tendon, call your doctor.

To diagnose Achilles tendon problems, such as tendinopathy or a tear, most doctors ask questions about your past health and do a physical exam. The exam includes checking for tenderness, watching how you walk and stand, and comparing the range of motion of your two legs.

Other tests may be done to clarify a diagnosis or to prepare for surgery. These tests include:

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Treatment Overview

Treatment for an Achilles tendon tear includes:

• Surgery. This is often used to reattach the ends of a torn Achilles tendon. Surgery works best when you have it soon after your injury. Surgery is followed by rehabilitation (rehab). Recovery may take months.
• Immobilizing your leg. This prevents movement of the lower leg and ankle. It allows the ends of the Achilles tendon to reattach and heal. It may take as long as 6 months to completely heal the tendon. A cast, splint, brace, walking boot, or other device may be used. This treatment is followed by rehab.

Treatment takes time, but it usually works. Most people can return to sports and other activities.

If you are healing from an Achilles tendon tear, don't smoke or use other tobacco products. Smoking slows healing. This is because it decreases blood supply and delays tissue repair.

Deciding about treatment

If you have a torn Achilles tendon, you may have a choice of treatment. You may have surgery to repair the tendon, or you may let it heal while using a cast or brace (immobilization). Both surgery and immobilization are usually successful. With either treatment, recovery will take months, and both will require rehabilitation (rehab).

You might want to consider surgery if:

• You are young or physically active.
• You want to reduce the risk of a future rupture. Another rupture is less likely after surgery than after immobilization.

You may not want to have surgery if:

• You are older or less active.
• You want to avoid the risks of surgery, such as infection.

Your doctor can help you weigh the pros and cons of these options so you can decide what's right for you.

Self-Care

Home treatment is often used as part of rehabilitation (rehab) after an Achilles tendon tear. Here are some things you can do to help you rest, heal, and strengthen your Achilles tendon. These can also help prevent further injury.

• Rest your Achilles tendon.

  Avoid all activities that strain the tendon. This includes climbing stairs and running. Try other things, such as swimming, while you give your tendon the days, weeks, or months it needs to heal. Your doctor will tell you what you can and can't do.

• Reduce pain.
  • Ice your Achilles tendon.
  • Take over-the-counter pain relievers like acetaminophen (such as Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) as directed. Be safe with medicines. Read and follow all instructions on the label.
• Follow your physical therapy program if one has been prescribed for you.

  Do gentle stretching and strengthening exercises. Focus on calf stretches.

• Don't smoke or use other tobacco products.

  Smoking slows healing. It decreases blood supply and delays tissue repair.

• Wear footwear that protects the tendon while it heals.
  • Quality athletic shoes that support your arches and cushion your heels can make a big difference in your comfort and healing. If needed, talk to your physical therapist or podiatrist about heel pads or orthotics.
  • A bandage that keeps your foot in a neutral position (not pointing up or down) can restrict the motion of the tendon.
  • A silicone sleeve or pad can distribute pressure on the Achilles tendon.
• Wear a night brace.

  Your doctor may suggest this if your Achilles tendon shortens and stiffens while you sleep. The brace keeps your foot in a neutral position.

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Surgery

Surgery is often used to reattach the ends of a torn Achilles tendon.

Surgery works best when you have surgery soon after your injury. Recovery may take months. Most surgeons will wait a few days for swelling to go down. Then they'll do the surgery as soon as they can. It's usually done within 4 to 6 weeks. You'll also need a rehabilitation (rehab) program to help heal and strengthen the tendon.

Surgery for an Achilles tendon tear can be done with a single large cut (incision). This is called open surgery. Or it can be done with several small cuts. This is called percutaneous surgery.

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Physical Therapy and Rehab

Rehabilitation (rehab) is part of the usual treatment for an Achilles tendon injury.

Your doctor or physical therapist will design a program for you. You will likely need rehab after an Achilles tendon injury whether or not you have surgery.

Rehab may include:

• Stretching and flexibility exercises. These help your tendon heal without shortening and causing long-term pain.
• Strengthening exercises. They help you regain strength in the tendon. And they will help protect you from another injury.
• Ultrasound heat therapy. It improves blood flow. This may aid the healing process.
• Deep massage. It helps with flexibility and blood circulation in the lower leg. It can also help prevent further injury.
• Endurance activities, such as riding a stationary bike.
• Coordination and agility training.

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