When one speaks of an Achilles tendon tear or rupture , one means a complete severing of the Achilles tendon. This connects the calf muscle with the heel bone. The most common Achilles tendon tears occur during exercise, when the foot is jerked around or is otherwise heavily used. Severe pain and a loud, whip-like bang then indicate a ruptured Achilles tendon.
What is an Achilles tendon tear?
When one speaks of an Achilles tendon tear or rupture, one means a complete severing of the Achilles tendon.
The Achilles tendon connects the heel bone with the calf muscles. As the strongest tendon in the human body, it is essential for walking and running.
It ensures that the heel can lift off the ground. If it is completely or partially severed, it is referred to as an Achilles tendon tear or rupture.
This occurs suddenly and only rarely announces itself in advance through pain. In most patients it is covered, that is, without any external injuries.
A rupture of the Achilles tendon caused by external influences such as the action of glass or sharp-edged objects is possible, but less well known in practice.
The Achilles tendon tear is a typical sports injury . Constant sporting and other stresses lead to signs of wear and tear, which then exceed the mechanical load-bearing capacity of the tendon tissue in the event of sudden tension or a kick.
Sports with a very rapid change of direction (for example handball or soccer) promote the frequency of the injury. Pre-existing illnesses such as diabetes mellitus also reduce stress tolerance. Men are more often affected by this injury than women.
The Achilles tendon tear is clearly audible and is accompanied by a bang (crack of a whip). This is followed by severe pain in the heel area. A dent is clearly palpable above the heel. If the Achilles tendon ruptures, the patient can no longer walk on tiptoe.
Symptoms, ailments & signs
An Achilles tendon tear is primarily associated with very severe pain. These usually occur directly on the tendon on the foot and can also radiate into the neighboring regions. This leads to very severe [foot pain | pain in the entire foot]] and usually also on the leg of the person concerned.
Furthermore, the patients suffer from bleeding in the affected region and associated severe swelling. The pain also occurs at night due to the Achilles tendon rupture, so that most patients also suffer from sleep problems or from depression and irritability . The quality of life is honestly restricted.
There are restrictions in movement and thus also severe restrictions in the everyday life of the person concerned. Ordinary movements are no longer possible for the person concerned. Due to the Achilles tendon tear, the entire load capacity of the foot decreases, so that even strenuous activities can no longer be carried out without further ado.
It usually takes a few months for the foot to regain its resilience. This crack can also cause a loss of strength. Due to the severe restrictions in everyday life, some people affected by the crack also suffer from psychological complaints or depression .
Diagnosis & course
Various methods are used for diagnosis. Usually the doctor will perform the Thompson calf compression test at the beginning. Furthermore, imaging methods such as ultrasound and x-rays are used.
The prognosis in the event of a ruptured Achilles tendon for complete restoration of the load-bearing capacity of the foot depends to a large extent on the treatment measures and the patient’s athletic demands.
A torn Achilles tendon that is not treated usually results in a loss of strength. A regenerated tendon forms within two to four months, but it is not a full replacement for the Achilles tendon.
On the other hand, professional therapy and consistent follow-up treatment almost always lead to the restoration of the load-bearing capacity of the Achilles tendon. For competitive athletes, however, the prognosis can be far more negative and lead to the end of their careers.
A rupture of the Achilles tendon can be prevented by avoiding rapid, abrupt and extreme loads.
If an Achilles tendon rupture is operated on, structures nearby can be injured. Bruising, bleeding, secondary bleeding and circulatory disorders can occur. If nerves are injured, sensory disturbances and symptoms of paralysis can occur.
In addition, the anesthesia also carries a certain risk. In addition, wound healing disorders, wound infections, excessive scarring and infections can occur. The tendon can shorten or lengthen. If a blood congestion cuff is used, pressure damage, for example paralysis, can be caused.
Swelling that lasts for a long time may occur after the operation. The swelling can cause problems during subsequent therapy – for example when adjusting the shoes. Sensitivity disorders can occur in the area of the surgical scar.
A bandage is usually applied when the Achilles tendon ruptures. The pressure in the bandage can damage blood vessels and nerves. The restricted movement can weaken muscles and bones. It can also be a so-called Sudeck syndrome come. The bone is severely broken down and a painful inflammation results. Blood clots can also form. In addition, allergic reactions with varying degrees of severity can occur.
A torn Achilles tendon increases the risk of leg vein thrombosis. In addition, a new crack, a so-called re-repture, can occur. Overall, the function of the Achilles tendon can be restricted after a tear.
When should you go to the doctor?
A ruptured Achilles tendon should receive medical attention as soon as possible. A visit to the doctor is recommended even if a serious injury to the Achilles tendon is suspected. Anyone who suddenly feels severe pain in the tendon area while exercising, which may be associated with a whip-like noise, should see a doctor immediately. This is particularly advisable if the symptoms persist or intensify quickly after exercise.
If the foot can no longer be unrolled as before, there may be a tear in the Achilles tendon that needs to be treated. Restrictions in the movement of the toes (the foot can no longer be “bent down”) also indicate an injury that requires treatment.
In general, complaints in the area of the calves or heels that persist after the usual regeneration phase must be medically clarified and, if necessary, treated. In the case of acute pain, first aid measures in the form of cooling compresses and rest should be taken. In the event of severe pain or paralysis in the foot, an ambulance service should be called in.
Treatment & Therapy
First of all, it is important to take the right immediate measures in the event of a ruptured Achilles tendon. The foot must be relieved, cooled, bandaged and raised.
Depending on the patient’s personal factors, the doctor can then decide between conservative and surgical therapy. Even if you decide to have an operation in most cases, you will resort to the non-surgical method of treatment if certain conditions are met. Age, smoking , possible arterial circulatory disorders or the use of certain medications are particularly risk factors .
A firm bandage (bandage, plaster of paris, orthosis) initially immobilizes the injured foot in the tip foot position for about a week. This is followed by a special shoe with a removable heel raised for a period of about 6 weeks.
During an operation, the two ends of the Achilles tendon are put back together. The suture can be reinforced by the muscular skin of neighboring muscles. The operation is followed by physiotherapeutic measures to restore mobility as quickly as possible.
Here, too, a special shoe is used to gradually increase the load on the Achilles tendon. Longer immobilization of the lower leg is not recommended in the event of a ruptured Achilles tendon.
Outlook & forecast
In most cases, a ruptured Achilles tendon can be treated surgically. Depending on the time of the intervention and the patient’s constitution, the tendon can usually be restored to its original range of motion. However, as a result of an operation, redness and itching, as well as thickened areas and scars, can remain, which can lead to movement disorders. In spite of successful therapy, some patients complain of swelling, pain or a reduced load-bearing capacity of the affected leg.
Rarely, infections , circulatory disorders or a shortening of the tendon can also occur. In the case of newly healed tears, there is a risk that the tendon will tear again and must be treated again. In general, several months of follow-up treatment is necessary for a ruptured Achilles tendon. After three to four months, the injury should be healed and the person affected can be active again. Competitive training should not be restarted until at least six months after a tendon rupture. Otherwise, it can lead to another crack and the development of chronic complaints.
Older patients who have already torn their Achilles tendon are at risk of further injuries and chronic pain. If there is another disease of the tendons, joints or muscles , this can also affect the prognosis.
A torn Achilles tendon is treated surgically in order to restore the functionality of the calf muscles and thus the normal way of walking. Follow-up care by the patient and doctor is important in order to optimize regeneration. Physiotherapists are also involved in the aftercare process.
Essentially, it is about allowing the sutured Achilles tendon to heal completely so that it can function properly again. For this it is important that the tissue is not overused for a period specified by the doctor. Athletes in particular, who understandably would like to start training again, must not strain the Achilles tendon too early and too intensively.
Light doses at the beginning of training are just as important as breaks to regenerate between units. Consistent pre-stretching is just as important as post-stretching after exercise. Both should be done gently and should not cause pain. Special focus should be placed on the calf muscles, which exert direct tension on the Achilles tendon and must therefore not be shortened.
The footwear is an essential factor in the follow-up care for a ruptured Achilles tendon. Because high heels promote cramping of the muscles of the calf and thus indirectly put a lot of strain on the Achilles tendon. Flat shoes are much cheaper in this context, as is walking barefoot.
You can do that yourself
As with most acute sports injuries, if you tear your Achilles tendon, there are good ways to help yourself. Doctors recommend the PECH rule to patients, which is also used in first aid . Even sprains and fractures can be optimally cared for on your own.
The individual letters of the acronym stand for pause, ice, compression and elevation. In detail, this means: Put up the injured part of the body, protect it and, in the best case, no longer move it. Furthermore, the affected area must be cooled . You can do this with either an ice pack or a piece of cloth soaked in cold water. Behind the point Compression is the instruction to connect the injury. The reason for this is not only to stabilize the affected area, but also to prevent too much blood or secretion from leaking into the surrounding tissue. In principle, however, the associationmust not be placed too tightly, otherwise there is a risk of aggravation. The last important step is elevation. The injured limb should be propped up on a pillow or chair – as a rule of thumb, medical professionals advise that it should be higher than the heart.
However, it is important that a doctor classifies the injury in order to rule out serious injuries before the patient begins his own measures.