An Achilles Tendon Tear: Symptoms, Causes and Care

The largest tendon in the body, the Achilles tendon connects our calf muscles to our heel bones. Involved in walking, running, and jumping, the Achilles tendon is incredibly strong, but nevertheless is still vulnerable to injury and rupture. An Achilles tendon tear is a separation of the tendon’s fibers, which causes pain, discomfort, and an interruption to normal daily functioning. This article will detail the symptoms, causes, and care options for an Achilles tendon tear, as well as ways to prevent the injury or prevent its recurrence.

What’s in a Name?

The Achilles tendon is named after the legendary figure Achilles. The myth of Achilles says that his mother Thetis was so concerned over her son’s mortality, she dipped him in the River Styx, whose waters supposedly leant the invulnerability of the gods. Her grip on Achilles was at his heel, and was so tight that the water never touched that part of him, making the heel of Achilles his only vulnerability.

Causes of an Achilles Tendon Tear

You are using your Achilles tendon with every step you take, and though it’s a remarkably durable part of your body considering the strain it’s always under to perform, sometimes the tendon is stretched too far. In that instance your tendon might rupture or tear. Common causes for this injury include the following.

• Increased sports participation, especially in activities that involve jumping.
• Stepping unexpectedly into a hole.
• Falling from a significant height.

Your Achilles tendon allows you to push off from your heel and rise onto your toes when walking and jumping, and when a rupture or tear occurs it’s usually within 6 centimeters or 2.5 inches from where it attaches at your heel bone. Blood flow is notably poor in this area of the body, which not only makes it more prone to injury, but also means that it can take longer to fully heal.

Those Most at Risk of Achilles Tendon Tears

Though everyone is technically at risk of tearing their achilles tendon (accidents can happen to anyone), there are some risk factors that make some more vulnerable to this injury than others.

• Recreational sports players: Those who play recreational sports like basketball, tennis, soccer, etc., which involve competitive running, jumping, and sudden halts and turns, are in a more high-risk category for Achilles tendon injuries.
• Age: Most Achilles tendon ruptures occur between 30-40 years of age, not in high school or college athletes, and not in those over 40 or 50 who have maybe ceased certain strenuous sporting activities.
• Sex: Statistics show that men are 5 times more likely to rupture their Achilles tendon than women, and that’s not a social or behavioral phenomenon. There may be sex-differences between the properties of Achilles tendons in men and women that cause men to be more at risk.
• Obesity: Excess weight puts strain on not only the Achilles tendon, but also on the knees, hips, and backs of those who are obese, leading to a greater likelihood of injury.
• Steroid injection: Some health care providers elect to inject steroids into the ankle to reduce inflammatory pain, but this may weaken the area, and has been associated with subsequent Achilles tendon tears.
• Fluoroquinolone antibiotics: Antibiotics like levofloxacin (Levaquin) and ciprofloxacin (Cipro) are fluoroquinolone antibiotics (used in humans to primarily treat respiratory and urinary tract infections), which can increase a person’s risk of Achilles tendon rupture.

Symptoms of an Achilles Tendon Tear

Here are the Achilles tendon pain symptoms you may experience (which may also include Achilles heel pain and/or Achilles calf pain as this damage can affect the whole lower leg area). Some injuries may be minor, and some will require medical or surgical intervention, which we’ll discuss further on. First up, the signs of an Achilles tendon injury.

• A snap, crackle, or popping sound that accompanies a sharp pain around your ankle or lower leg.
• Inability to “push off” from your heel and stand up on tippy toe.
• Trouble moving your foot or ascending stairs.
• Bruising or swelling in your foot, heel, or lower leg.
• A sensation like the back of your ankle has been hit (as if someone took a bat to it, or you’ve been kicked).

Diagnosis and Treatment Options

If you suspect an Achilles tendon injury, you should seek medical advice right away to avoid exacerbating or re-injuring the damaged area. Surgery is often needed to treat an Achilles tendon rupture or tear, but consult with your doctor on whether nonsurgical treatment is an option that can be tried first, as surgeries can be costly, risky, and unwelcome. Your doctor will most likely diagnose you with a physical exam, and perhaps an MRI imaging test to ascertain whether you’ve sustained a partial tear (meaning that some of the tendon is still intact and okay), or a full tear (which means the two ends of the tear are no longer attached).

Nonsurgical Treatment Options

Nonsurgical options for treatment of an Achilles tendon tear include placing the foot into a splint, cast, or cast-boot to hold it in the plantar flexion position (a pointed toe or tippy toe position). Nonsurgical healing may still take weeks or months to see the tendon fully repaired, and even so the area can remain vulnerable. This form of healing may be done with or without physiotherapy, but even these nonsurgical options should not be attempted lightly, or without medical consultation: these are possible options if one wishes to avoid surgery, but they may not ultimately do the trick if they’re not done properly. A doctor may want to avoid surgery depending on certain conditions in you, their patient, and may take into account the following risk factors for surgical intervention.

• The patient’s age
• A history of smoking (smokers and former smokers have higher risk of complications from surgery)
• The patient’s activity level
• Other medical conditions (for example, diabetics have a higher risk of surgical complications)
• The patient’s reluctance towards surgery

Surgical treatment may not be the best for everyone, but a conversation with your diagnosing physician and/or an orthopedic surgeon should be had to find your ideal solution.

Surgical Treatment of Acute Achilles Tendon Rupture

During this surgery, the ends of the torn Achilles tendon will be exposed and sutured together to reattach them securely so that healing can take place. Surgeons are trained to make sure their sutures are neither too tight nor too loose, as either scenario might hamper recovery. Surgeons are also careful with the surrounding soft tissue of the area to avoid causing nerve damage or infection.

Surgical repair works best when it is performed sooner rather than later, before scar tissue can begin to form. Fortunately in recent years, these surgeries can be done with minimally invasive smaller cuts. Ask your surgeon how they are best prepared to perform the surgery (some will prefer larger incisions if it means a stronger suture), and make your own personal decision on what kind of surgeon/surgery your injury needs.

Surgical Treatment of Chronic Achilles Tendon Rupture

This is a more complicated surgery for a more serious condition, wherein the Achilles tendon has retracted into the leg and scarred into that shortened position. Restoring the tendon length is the aspect that makes this procedure more difficult, and its recovery longer.

The methods used to re-lengthen the tendon include a turndown procedure that folds down tissue from the top of the calf to add more length. Another method is transferring tendons from other areas of the ankle to bridge the gap. While these procedures for chronic Achilles tendon tears are often not as successful as the acute surgeries, they are nevertheless the best option in some cases to restore some functioning of the Achilles tendon.

Post-Surgery Rehab and Recovery

Surgeons will frequently release their patients with walking boots or splints to help support the Achilles tendon as it heals and as the patient starts walking normally again (more at-risk patients may be given an immovable cast at first as well). The good thing is that movement can often begin immediately following surgery, so while patients will need protective gear as they recover, they are still encouraged to begin walking and moving, and in some cases physical therapy will be prescribed to help with safe stretches, quicker strengthening, and effective exercises. The timeline of recovery for most patients involves resuming regular walking in 4-6 weeks, recovering their strength in about 8 weeks, and returning to exercise after 3 months. Returning to sports, however, can take as long as 6 months, and sometimes longer depending on the severity of the injury.

Prevention Going Forward

During physical therapy people learn exercises and stretches to strengthen their calf muscles over time, to encourage recovery, and to prevent re-injury. These stretches will be slow (no bouncing or using too much force), and some of the calf exercises may come with the following recommendations for going forward in health and fitness.

• When stretching, proceed slowly until you feel a pull, but stop before you are in pain.
• Increase your activity slowly and steadily as you return to your normal lifestyle.
• Vary the types of exercises you do once you’ve recovered, alternating high-impact (running) with low-impact sports (biking, swimming).
• Avoid or at least limit running on slippery or hard surfaces, and invest in a pair of well-fitted athletic shoes.
• Avoid sports and activities that excessively stress your Achilles tendons (jumping activities or hill running) to lessen the likelihood of future sports injuries.
• Beware that tendonitis may affect your Achilles tendon sporadically, and seek Achilles tendonitis treatment (icing, stretching, anti-inflammatory medications) to relieve the pain safely.

Healing Your Achilles Heel

Even once you heal, you still remain at a greater risk of re-injuring your Achilles tendon, so it’s also recommended that you stretch both before and after exercising, discontinue wearing any high-heeled shoes or boots, and as always ask your doctor for specific advice regarding what you can safely do (then take that advice to heart). The truth is that as we age our health becomes a more precious commodity, so whatever amount of use you regain after an Achilles tendon tear, treasure and protect that recovery, so that you can keep moving forward.