What is an Achilles tendon rupture?
The Achilles tendon (tendo calcaneus) connects the heel bone with the calf muscle (triceps surae muscle). With a length of 20 to 25 centimeters and a width of five centimeters, it is the strongest tendon in the human organism. They allow us to stand on tiptoe and push off when running and jumping. It can be easily felt through the skin just above the heel. During sport (especially ball sports, running, football, cycling), a multiple of the body weight acts on the Achilles tendon.
An Achilles tendon rupture occurs when the tendon is suddenly subjected to excessive strain or injured. It then usually tears completely; a partial tear (so-called partial Achilles tendon rupture) rarely occurs. The tear usually occurs at the narrowest point of the tendon, two to six centimeters above the insertion on the heel bone, at the so-called Achilles tendon waist. Occasionally, an Achilles tendon rupture also occurs in the area where the tendon attaches.
Achilles tendon ruptures are quite common: More than ten out of every 100,000 people suffer it every year, men up to ten times more frequently than women. The 30 to 50 age group is particularly affected. Achilles tendon ruptures are mainly caused by ball sports – they often affect people who are not very well trained.
The name Achilles tendon goes back to Greek mythology. The heel was the only part of the body where the hero Achilles was vulnerable. There he was hit by a deadly arrow.
Achilles tendon rupture: Causes and risk factors
Achilles tendon injuries occur most frequently during sport, especially ball sports. It usually occurs as a result of abruptly tensing the tendon. This happens, for example, during activities that require rapid stop-and-go movements, sprints or jumps. When the Achilles tendon ruptures, it is usually already damaged, for example due to the ageing process. Risk factors for an Achilles tendon rupture are, for example:
- older age
- Muscle dysfunctions
- male gender
- Taking (quinolone) antibiotics, anabolic steroids and cortisone
- Micro-injuries as a result of overloading, for example during sport
- Diseases such as diabetes mellitus
It is very rare for direct violence to cause an Achilles tendon rupture, for example a knife cut or a kick with a cleated shoe.
Symptoms: pain, swelling, restriction of movement
The Achilles tendon tears audibly with a loud crack, reminiscent of a whip crack. The sound is produced when the tendon is suddenly released by a jump or a kick.
Other symptoms you may experience include
- Severe, stabbing pain in the lower calf that feels as if you have been kicked in the tendon
- palpable dents and bruises above the heel
- Swelling of the calf and the back of the ankle joint
In addition, your ability to walk and stand is immediately significantly restricted. For example, you can no longer lift yourself onto the toes of the affected foot. Due to these typical symptoms, an Achilles tendon rupture is already suspected.
Achilles tendon rupture: Diagnosis with us
The diagnosis of an Achilles tendon rupture is not very complex. We usually recognize it quickly when you describe the course of the accident to us. We can also feel a visible dent under the skin above the Achilles tendon. As mentioned above, the clinical symptom that you can no longer stand on the tip of your toes is indicative of the diagnosis of an Achilles tendon rupture.
The so-called Thompson test provides further confirmation of an Achilles tendon rupture: lie on your stomach and let the injured leg hang freely. We squeeze your calf muscles. If the Achilles tendon is intact, the toes then move towards the sole of the foot. If the tendon is torn, this reflex does not occur.
Imaging procedures can contribute to the diagnosis:
- X-ray: The X-ray examination can rule out the possibility that parts of the bone are also injured (bony avulsion).
- Ultrasound (sonography): The ultrasound over the Achilles tendon region helps to determine the exact location of the tear and to check how far apart the ends of the injured tendon are.
- Magnetic resonance imaging (MRI): The MRI examination can be used to assess the tear more precisely. However, an MRI examination is not absolutely necessary for every affected person.
Achilles tendon rupture: Prevention, early detection, prognosis
Wear and tear processes within the tendon that are suddenly subjected to a heavy load are the main triggers of an Achilles tendon rupture.
The wear and tear of the tendon tissue of the Achilles tendon can already begin in young adulthood. In addition, a low level of fitness means that your entire muscle-tendon system is less elastic. Accordingly, people who are not very physically active have a higher risk of their Achilles tendon rupturing under strain.
This is how you can prevent it:
- Exercise regularly. Focus on gentle strength and endurance training. Increase the load gradually.
- If you are not very well trained, avoid extremely fast, abrupt and therefore heavy loads (e.g. squash, tennis, football), as they often lead to Achilles tendon ruptures.
- Warm up your muscles, tendons and joints before exercising and allow the physical activity to wind down slowly.
Since an Achilles tendon rupture is an accident and therefore a sudden event, early detection is not possible.
Course and prognosis
The course and prognosis of Achilles tendon ruptures depend heavily on the treatment. If it is carried out professionally and there is consistent follow-up treatment, it is almost always possible to restore the load-bearing capacity of the Achilles tendon and the function of the ankle joint. This allows you to regain your performance from before the tendon injury.
However, this positive prognosis does not apply to top athletes from the jumping and running disciplines: an Achilles tendon rupture often means the end of their career, as they are often unable to regain full resilience despite therapy and aftercare.
There is also an increased risk of thrombosis of the leg veins after an Achilles tendon rupture.
Achilles tendon rupture: Treatment
A torn Achilles tendon is an accident. If possible, first aiders should administer emergency treatment according to the PECH rule. This abbreviation stands for:
- Pause= interrupt activities immediately.
- Ice= Cool the heel area with ice.
- Compression= Apply a pressure bandage around the ankle.
- Elevated position= then elevate the leg.
Achilles tendon ruptures can be treated surgically or conservatively. The decision on the type of therapy is discussed individually with the patient. Conservative treatment may be considered if the tendon ends are not very far apart or if there are significant risk factors for surgery.
During surgical treatment, the tendon stumps are sutured together. This can be performed using an open or semi-open surgical technique.
Surgical and conservative treatment of Achilles tendon ruptures requires long-term follow-up treatment and rehabilitation lasting around three months. In addition, thrombosis prophylaxis should be administered to prevent the development of a potentially dangerous thrombosis in the affected lower limb.
At the Department of Traumatology at the USZ, specialists are available for patients with an Achilles tendon rupture, who carry out a precise examination and diagnosis and put together an individual treatment plan with the person affected.