Achilles Tendon Tears - How Do They Happen and How Are They Fixed
The recent news regarding professional soccer star David Beckham's Achilles tendon tear last week has renewed interest in this injury.
Unfortunately, injuries of this type are not uncommon, and prompt treatment is required to prevent long term problems from occurring, some of which can lead to chronic pain and disability.
This article discusses the nature of Achilles tendon ruptures, and how they are best treated.
The Achilles tendon is a strong, firm rope-like tissue that allows the muscles in the back of the legs to move the foot and ankle.
This motion effectively moves the ankle downward, and resists it from moving too far upward.
The Achilles tendon is powerful and sturdy, but is not always resistant to injury.
A tremendous amount of force is constantly applied to this tendon as it connects the foot to the leg during walking and standing.
The tendon has a natural weak area a couple inches above where it connects to the heel, called the 'watershed' region.
Chronic stress and strain can eventually cause tissue in this spot to weaken and fray.
This chronic stress and strain can come from walking on slopes, stairs, ladders, or other uneven surfaces regularly, or from simple repetitive athletic activities when one has not stretched their calf properly.
Over time the damage will gradually increase.
The tendon's weak spot has less blood supply than the rest of the tendon, so any low grade damage will multiply over time as the tendon is less able to heal itself in this spot.
Once the damaged area is weak enough, only a relatively minor injury is needed for the tendon to tear and rupture.
This is especially seen in people who have chronic Achilles tendonitis (inflammation) that ignore the warning pain and do not seek treatment.
The Achilles tendon can also be forcefully ruptured when it is strong and healthy.
This injury occurs when the ankle is violently forced upward while one's foot is resisting by pushing the ankle downward.
This can also occur when the knee is forcefully straightened while the ankle is flexed upward.
Direct injury to the tendon, such as cutting injuries like slicing the heel on glass or a lawnmower blade can also rupture the Achilles tendon.
Heavy pressure (without breaking the skin) directed exactly on the Achilles tendon can create the same injury.
Sometimes, one does not even need to have a significant injury or chronic strain to cause the Achilles tendon to rupture.
Certain diseases can produce a state in which the Achilles tendon is naturally weaker and more prone to rupture.
These include rheumatoid arthritis, gout, lupus, and tuberculosis.
The long term use of steroid medication for inflammation, or the injection of cortisone-like steroid in the Achilles tendon region can lead to a weakening of the fibers that compose the tendon itself.
A certain class of antibiotics can also produce the same effect.
Once the Achilles tendon has ruptured, walking becomes incredibly difficult and unsteady.
Those who have ruptured their Achilles tendon have reported hearing a popping or snapping sound, and feeling like they have been punched in the back of the heel.
It can be a searing pain that is soon followed by bruising, swelling, warmth increase to the skin, redness, and sometimes even a depression under the skin in thinner people if the Achilles tendon is prominent.
The foot will have more of a tendency to flop upwards, and bending the ankle downward will be difficult, if not impossible.
Because of this instability, walking on that leg will be very difficult.
Achilles tendon ruptures are fairly easy to diagnose for most physicians, although an MRI is often performed to confirm the rupture and assess the amount of tissue damage.
Upon examining, the doctor will note the swelling and pain, as well as a possible gap where the Achilles tendon is usually located.
The calf muscle may feel balled-up, and certain functionals tests will be performed to assess the strength and functional loss of the calf muscles.
The MRI will help guide the doctor in planning surgery to fix the tissue rupture, and will show if there is any other special injury pattern that needs to be considered, such as chronic tendon degeneration or a significant retraction of the tendon up into the leg.
Treatment usually requires surgery to repair the ruptured ends of the tendon.
The vast majority of these injuries are treated with surgery, as non-surgical treatment does not necessarily allow for the strongest repair and healing potential.
When needed, non-surgical treatment consists of placement in a below knee cast with crutches.
This can be performed on partial ruptures, but those with full ruptures of the Achilles tendon will need surgery.
There are those for whom surgery is not advisable due to age, health reasons or other complications, and that is why non-surgical care is sometimes performed in a full rupture.
Surgery consists of bringing the ruptured ends of the tendon back into a position where they are touching, stitching the ruptured ends together with strong non-absorbing suture, and holding the ankle locked into position for four to eight weeks while the split ends heal together.
It is very important the ankle does not move during this time, as the tendon could re-rupture prior to its healing if there is enough force to rip through the stitched areas.
When surgery is delayed for too long (weeks to months) following the injury, the tendon can retract up the leg, widening the gap between the torn ends.
This makes repair very difficult, and the tendon needs to be lengthened or grafts need to be used to bridge the gap and allow tendon tissue to creep across the severed ends.
Tendon lengthening can be done by making small cuts in the tendon substance above the rupture to stretch it downward, or it can be accomplished by releasing tight tissue near the calf muscle belly that holds the tendon suspended.
If this is not enough to bring the tendon ends back down together, then graft material has to be used to replace the lost tendon length.
This graft can be from another human, or it can be from an animal or artificial substance.
Regardless of what must be done to complete the repair, Achilles tendon repair surgery is usually followed by four weeks of non-weightbearing with a below knee cast and crutches, with at least four weeks of protective weightbearing to follow.
Physical therapy and rehabilitation is necessary after the tendon is strong enough not to rupture again in the post-operative time period.
A return to full activity, especially for a world class athlete like David Beckham, can take many months all together.
As one can see, Achilles tendon ruptures are serious injuries that, although not life threatening, can lead to serious disability if not promptly and correctly treated.
Surgery is usually necessary, and a protective recovery period is needed for the best results.
Unfortunately, injuries of this type are not uncommon, and prompt treatment is required to prevent long term problems from occurring, some of which can lead to chronic pain and disability.
This article discusses the nature of Achilles tendon ruptures, and how they are best treated.
The Achilles tendon is a strong, firm rope-like tissue that allows the muscles in the back of the legs to move the foot and ankle.
This motion effectively moves the ankle downward, and resists it from moving too far upward.
The Achilles tendon is powerful and sturdy, but is not always resistant to injury.
A tremendous amount of force is constantly applied to this tendon as it connects the foot to the leg during walking and standing.
The tendon has a natural weak area a couple inches above where it connects to the heel, called the 'watershed' region.
Chronic stress and strain can eventually cause tissue in this spot to weaken and fray.
This chronic stress and strain can come from walking on slopes, stairs, ladders, or other uneven surfaces regularly, or from simple repetitive athletic activities when one has not stretched their calf properly.
Over time the damage will gradually increase.
The tendon's weak spot has less blood supply than the rest of the tendon, so any low grade damage will multiply over time as the tendon is less able to heal itself in this spot.
Once the damaged area is weak enough, only a relatively minor injury is needed for the tendon to tear and rupture.
This is especially seen in people who have chronic Achilles tendonitis (inflammation) that ignore the warning pain and do not seek treatment.
The Achilles tendon can also be forcefully ruptured when it is strong and healthy.
This injury occurs when the ankle is violently forced upward while one's foot is resisting by pushing the ankle downward.
This can also occur when the knee is forcefully straightened while the ankle is flexed upward.
Direct injury to the tendon, such as cutting injuries like slicing the heel on glass or a lawnmower blade can also rupture the Achilles tendon.
Heavy pressure (without breaking the skin) directed exactly on the Achilles tendon can create the same injury.
Sometimes, one does not even need to have a significant injury or chronic strain to cause the Achilles tendon to rupture.
Certain diseases can produce a state in which the Achilles tendon is naturally weaker and more prone to rupture.
These include rheumatoid arthritis, gout, lupus, and tuberculosis.
The long term use of steroid medication for inflammation, or the injection of cortisone-like steroid in the Achilles tendon region can lead to a weakening of the fibers that compose the tendon itself.
A certain class of antibiotics can also produce the same effect.
Once the Achilles tendon has ruptured, walking becomes incredibly difficult and unsteady.
Those who have ruptured their Achilles tendon have reported hearing a popping or snapping sound, and feeling like they have been punched in the back of the heel.
It can be a searing pain that is soon followed by bruising, swelling, warmth increase to the skin, redness, and sometimes even a depression under the skin in thinner people if the Achilles tendon is prominent.
The foot will have more of a tendency to flop upwards, and bending the ankle downward will be difficult, if not impossible.
Because of this instability, walking on that leg will be very difficult.
Achilles tendon ruptures are fairly easy to diagnose for most physicians, although an MRI is often performed to confirm the rupture and assess the amount of tissue damage.
Upon examining, the doctor will note the swelling and pain, as well as a possible gap where the Achilles tendon is usually located.
The calf muscle may feel balled-up, and certain functionals tests will be performed to assess the strength and functional loss of the calf muscles.
The MRI will help guide the doctor in planning surgery to fix the tissue rupture, and will show if there is any other special injury pattern that needs to be considered, such as chronic tendon degeneration or a significant retraction of the tendon up into the leg.
Treatment usually requires surgery to repair the ruptured ends of the tendon.
The vast majority of these injuries are treated with surgery, as non-surgical treatment does not necessarily allow for the strongest repair and healing potential.
When needed, non-surgical treatment consists of placement in a below knee cast with crutches.
This can be performed on partial ruptures, but those with full ruptures of the Achilles tendon will need surgery.
There are those for whom surgery is not advisable due to age, health reasons or other complications, and that is why non-surgical care is sometimes performed in a full rupture.
Surgery consists of bringing the ruptured ends of the tendon back into a position where they are touching, stitching the ruptured ends together with strong non-absorbing suture, and holding the ankle locked into position for four to eight weeks while the split ends heal together.
It is very important the ankle does not move during this time, as the tendon could re-rupture prior to its healing if there is enough force to rip through the stitched areas.
When surgery is delayed for too long (weeks to months) following the injury, the tendon can retract up the leg, widening the gap between the torn ends.
This makes repair very difficult, and the tendon needs to be lengthened or grafts need to be used to bridge the gap and allow tendon tissue to creep across the severed ends.
Tendon lengthening can be done by making small cuts in the tendon substance above the rupture to stretch it downward, or it can be accomplished by releasing tight tissue near the calf muscle belly that holds the tendon suspended.
If this is not enough to bring the tendon ends back down together, then graft material has to be used to replace the lost tendon length.
This graft can be from another human, or it can be from an animal or artificial substance.
Regardless of what must be done to complete the repair, Achilles tendon repair surgery is usually followed by four weeks of non-weightbearing with a below knee cast and crutches, with at least four weeks of protective weightbearing to follow.
Physical therapy and rehabilitation is necessary after the tendon is strong enough not to rupture again in the post-operative time period.
A return to full activity, especially for a world class athlete like David Beckham, can take many months all together.
As one can see, Achilles tendon ruptures are serious injuries that, although not life threatening, can lead to serious disability if not promptly and correctly treated.
Surgery is usually necessary, and a protective recovery period is needed for the best results.
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