Achilles Tendon Tear

The Achilles tendon-also called the heel cord-is a strong, fibrous tissue connecting the heel bone to the muscles of the lower leg. Since the leg muscles are the most powerful muscles in the body, the Achilles tendon is the strongest tendon in the body. The Achilles tendon helps to point the foot down, rise up onto your toes and push off when you walk. 

If the tendon is stretched too far, it can tear, either partially or completely. Usually the tear occurs just above the heal bone, but it can happen anywhere along the length of the tendon.

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Symptoms

There is usually a pop or a snap that signals an Achilles tendon tear, followed by sometimes severe pain at the back of the ankle and lower leg. The injury makes walking normally impossible and feels as if you have been kicked, hard. Swelling often follows the injury. If the tear is complete, you will not be able to rise up on your toes.

Causes and Risk Factors

An Achilles tendon can tear through overuse, improper footwear, accidents or if it is misaligned. Suddenly changes in speed, such as from walking to running or running up hill or on hard surfaces puts increased strain on the Achilles tendon, which can increase the risk of a tear. The stop-and-start nature of tennis, racquetball and basketball can increase the risk of an Achilles tendon tear. Alternating between high-heeled shoes and running shoes can also strain the tendon and risk a tear.

Staying in good shape and stretching before exercising or participating in sports are excellent ways to avoid tearing an Achilles tendon. Strengthening the calf muscles slowly, without bouncing, can also help decrease the risk of an Achilles tendon tear.

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Diagnosis

Other conditions, such as bursitis or tendonitis can cause similar symptoms to a partial Achilles tendon tear, so a thorough diagnosis is crucial. A physician will ask questions about recent activities and examine the foot, ankle and leg. An MRI may be used to determine the extent of a tear, while a rupture is usually apparent without such a test.

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Treatments

A rupture of the Achilles tendon will worsen if not promptly treated. Usually complete immobilization of the tendon is required and surgery is performed to repair a rupture and tears, if the tear is severe.

Nonsurgical treatment often involves wearing a cast or walking boot, which allows the ends of the tendon to reattach themselves. Recovery can take longer than with surgery and the risk of re-rupture is higher than with surgery.

Surgery is usually very effective and the risk of complications low. During surgery, a physician will make an incision at the back of the lower leg and stitch the torn tendon back together. If the torn tendon is in poor condition, it may be reinforced with tendon from other parts of your body. Recovery includes spending six to 12 weeks wearing a walking boot, cast or brace.

Most patients, whether surgical or non-surgical can return to their former level of activity within four to six months.

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