Introduction
Anatomy
Cause
Symptoms
Diagnosis
Non-surgical treatment
Surgical treatment
Rehabilitation
Prevention
Ruptured tendoachilles usually happens to “weekend sportsmen” (people who do their favorite sports on the weekends only) or professional athletes. Some famous soccer players, badminton players and figure skaters, for example, have suffered from this painful condition.
Ruptured tendoachilles means the Achilles tendon is broken into two parts. Achilles tendon is the main tendon activated during movement of the calf. The tendon stretches from the top of the heel bone to the lower part of the calf and is indispensable for the kicking, jumping and lifting actions of the feet. Its name originates from Greek mythology, in which Achilles is a tremendously strong and invincible warrior god. His only weakness is in the back of the heels.
Although Achilles tendon is the largest tendon in the body, it is located underneath a thin layer of skin on the back of the heels, which lacks protection from muscles and fat and has relatively weak blood circulation. These factors, in addition to the contraction of the calf muscles, make Achilles tendon one of the most vulnerable parts of the body and thus prone to injury.
Those who are not used to regular exercise and muscle strengthening are more prone to ruptures of the Achilles tendon, which usually occur during movements that involve a sudden increase in speed and jumping actions. Activities involving the exertion of explosive force by the calves, such as basketball, badminton, volleyball and tennis, could trigger ruptured tendoachilles.
When the Achilles tendon is ruptured, the patient would feel as if there is a strong external force hitting the back of the heels, causing sharp pain and making it impossible to lift the heel or support the body weight.
The symptoms of ruptured tendoachilles are not as obvious as those of bone fractures, especially in cases of partial ruptures, which are often ignored by the patient or misdiagnosed as ankle sprains. If it is a total rupture, the patient would experience a complete loss of strength and would be more likely to seek help.
After the Achilles tendon is ruptured, the two ends of the tendon would shrink and the calf muscles would start to shrink. After two to three weeks, when the bruise subsides, a hollow would show up at the point of rupture and be filled with scar tissues. The patient would find it very difficult to lift the leg, let alone walk or run. If this condition remains untreated, the two ends of the tendon would be separated for up to 7 to 8 cm. At this time, it would be extremely difficult to reconnect the ruptured tendon.
If the Achilles tendon is ruptured, the patient can still walk, but sometimes unsteadily as lifting the leg would be very difficult. It would also be impossible to stand on the ball of the feet with the heel lifted.
Examination of the calf would reveal the back of the heel being swollen and a gap in the region near the heel bone. The length of the gap is the distance between the two ends of the torn tendon. The hollow area is often uneven and the position may not be very clear. To diagnose if the Achilles tendon is really ruptured, a Thompson Test or ultrasound exam should be performed.
During a Thompson Test (see photo), the patient lies on the bed facing down, with the knees bent and the feet dangling in the air. The tester then presses gently on the calf muscles to test if there is still any connection between the calf and the heel. If the foot does not move, then the Achilles tendon is most likely ruptured. The best way is to seek diagnosis from an orthopaedic specialist.
Because the Achilles tendon is located under a thin layer of skin on the back of the heel, there is a lack of protection by fat and muscles, and the circulation is also relatively weak. As a result, it is quite difficult for the wound to heal if surgical repair is not properly performed. The risk of wound complication is also relatively high. Therefore it is understandable that conservative methods, such as using a cast to stabilise the heel and let the tendon heal naturally, are often used.
The latest studies show that it takes a relatively longer time for the tendon to heal if non-surgical methods are used to treat ruptured tendoachilles. In addition, the possibility of a re-rupture is quite high. On the other hand, a properly performed surgery can greatly reduce such possibility. It can be performed either by open methods or through a minimally invasive approach. Consultation with an orthopaedic specialist will determine the type of surgical treatment that is right for you.
Whether it is conservative treatment or surgery, rehabilitation is necessary after the cast is taken off. Specific exercises can help the Achilles tendon and calf muscles to restore their functions. Only when the tendon reaches a certain level of strength and stretching ability can the patient resume sports or activities that require rigorous movements of the calves and heels.
Muscles and tendons would not easily get injured if a person has been training regularly, with proper warm-up and muscle stretching beforehand. However, if a person lacks regular training, the muscles would be unprepared for sudden contractions. Under such conditions, if the person engages in activities that involve “explosive” muscles forces, the chance of injury would be higher. It is no surprise that “weekend sportsmen” are more likely to rupture their Achilles tendon.
Simple, regular exercises at home or at work are therefore recommended to train calf muscles. These exercises include lifting of the legs with weights around the feet, dancing, kicking the legs and more. Of course, always remember to warm up and stretch the limb before doing any exercises.
Dr. MAK, Kan-hing