Achilles Tendon Tear

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An Achilles tendon tear occurs when the tendon attaching the calf muscle to the heel is completely torn. This is a common injury, most often seen in middle-aged male weekend warriors.

Three Things About the Achilles

  • The Achilles tendon is the largest tendon in the body. Despite being the largest tendon in the body, the Achilles is still prone to injury. Large forces are exerted on the Achilles, particularly with sudden, explosive movements seen in sports that involve running and jumping.
  • Men are about 7 times more likely to tear their Achilles. Men are much more likely to sustain an Achilles tendon rupture. Most often this injury is seen in a 20-40 year old athlete, and often occurs without any contact or collision. 
  • Certain antibiotics and cortisone shots may make you more likely to tear your Achilles. A specific type of antibiotic, called fluoroquinilones (such as Cipro or Levaquin), have been shown to increase the likelihood of Achilles tendon problems. Cortisone shots are also associated with Achilles tears, a reason many doctors don't recommend cortisone for Achilles tendonitis.

Symptoms of a Torn Achilles Tendon

An Achilles tendon tear, or rupture, is a traumatic injury that causes sudden pain behind the ankle. Patients may hear a 'pop' or a 'snap,' and will almost always say they feel as though they have been kicked in the heel (even though no one has kicked them). Patients have difficulty pointing their toes downward, and may have swelling and bruising around the tendon.

Your doctor will examine the ankle for continuity of the tendon. A defect in the Achilles tendon can often be felt after a tear. In addition, squeezing the calf muscle should cause the foot to point downwards, but in patients with a torn Achilles tendon, the foot will not move (this will cause positive results on the Thompson test).

X-rays may be performed to evaluate for other conditions including an ankle fracture or ankle arthritis.

Risks that May Causes a Torn Achilles Tendon

Achilles tendon ruptures are most commonly seen in men who are around the age of 30 or 40. About 15 to 20% of patients have symptoms of Achilles tendonitis prior to sustaining an Achilles tendon tear, but the vast majority of patients have no history of prior Achilles tendon problems. Over 75% of Achilles tendon tears are associated with playing ball sports (commonly basketball or tennis).

Other risk factors that are associated with Achilles tendon rupture include:

Fluoroquinolone antibiotics are used very commonly in medicine for treatment of respiratory infections, urinary tract infections, and other bacterial infections. These antibiotics, such as Cipro, Levaquin, and others, are associated with Achilles tendon rupture. Exactly why this is the case is unclear, but patients on these medications should consider an alternative medication if Achilles tendon pain develops.

Treatment of an Achilles Tendon Tear

Treatment of an Achilles tendon tear can consist of either surgery or non-surgical techniques. The benefit of surgery is there is often less immobilization. Athletes can often get back to sports faster, and there is probably a smaller chance of re-rupture of the Achilles tendon. The advantage of non-surgical treatment is that the potential surgical risks are avoided, and the long-term functional results are similar to those patients that undergo surgical treatment.

Sources:

Chiodo CP, et al. "Diagnosis and Treatment of Acute Achilles Tendon Rupture" J. Am. Acad. Ortho. Surg., August 2010; 18: 503 - 513.

van der Linden PD, et al. "Fluoroquinolones and risk of Achilles tendon disorders: case-control study" BMJ 2002;324:1306.

Schepsis, AA, et al. "Achilles Tendon Disorders in Athletes" Am. J. Sports Med., March 1, 2002; 30(2): 287 - 305.

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