Achilles tendon rupture

(6)

Achilles tendon rupture may affect people of any age, during any type of sport. It mostly occurs during activities requiring a propulsion that creates sudden and fatal tension of the tendon.

What is the Achilles tendon

The Achilles tendon is the final tendon connecting the triceps (calf muscle) to the calcaneum (heel bone)

The triceps is part of a muscle called the gastrocnemius muscle. It is a very powerful muscle and even if the Achilles tendon is the most voluminous and powerful muscle in the body, it cannot always take the tensions induced by exercise and may break brutally.

It is a common injury in athletes, but it may also occur in everyday life during recreational activities.

Sports affected

If any sport can be concerned by an Achilles tendon rupture, this condition is generally observed in athletes who do sports involving successive changes in rhythm and trajectory. These include tennis, team sports such as football, handball, basketball and rugby, as well as individual sports such as squash, badminton or even karate and judo.

In short, any sport may be concerned when there was a pre-existing weakness.

Conditions of occurrence

  • More frequent in men than women
  • Age: between 30 and 40 years old
  • "Stabbing from a clear sky", which means it is both sudden and very painful
  • In athletes, whatever their level of practice, but mostly observed in occasional athletes whose workout is inappropriate, or due to an accumulation of local fatigue at the end of a workout
  • During a start, a jump, an impulsion, or a change of direction
  • Rarely because of a direct shock

Predisposing conditions to the occurrence of a rupture

  • Repeated infiltrations of corticosteroids,
  • Ignored or inappropriately treated chronic tendinitis
  • Use of antibiotics (see www.irbms.com)
  • Disorders of the static plantar posture or imbalance of the pelvis
  • Overweight
  • Distant dental problem
  • Wrong technique or wrong equipment, including shoes with worn out soles

Conditions of occurrence and initial management

During exercise, onset of very acute pain with fall and incapacity to get up. Real stabbing pain.

Management of this trauma must be started in the field, and includes:

  • stopping sports
  • immobilisation if possible or complete resting discharge
  • applying ice
  • Above all, doing nothing: no massaging, no testing the foot "just to see".

Advice from an IRBMS (institute of sports biology and medicine) professional: Remember the RICE protocol: R for rest, I for ice, C for contention, E for elevation

Then evacuate the injured to an emergency department, or to their sports physician.

Signs confirming the rupture

The doctor will first ask about the circumstances of the injury, then perform a physical examination to find any swelling (edema) hiding the tendon anatomy. Haematoma or bruising may be observed. The doctor induces pain by palpating the tendon.

The doctor asks the athlete to lie down on their stomach, with feet outside the examination table, in order to observe that the injured foot is no longer rolling down.

Then if possible, and with great care, the doctor will ask to come up to tiptoe, with the assistance of the non-injured side, but in case of a rupture, it is impossible to stand on tiptoe.

Additional examinations

A muscle-tendon ultrasound will confirm a total or a partial rupture

The following may also be done:

X-ray (when a fracture is suspected or to assess calcifications)

MRI if needed but not required

Treatment of an Achilles tendon rupture

Most of the time, the proposed treatment is surgical with post-surgery plaster cast immobilisation

The non-surgical orthopaedic treatment with the foot immobilised in equinus should be reserved to cases of surgical contra-indication. It is usually not recommended in athletes.

Despite the cast, an athlete can continue to develop leg muscles through regular contractions, in order to prevent losing too much muscle under the cast.

Post-surgery rehabilitation

The physiotherapist plays a very important role in the progressive return to walking, and then sports.

Balneotherapy sessions may also be suggested to provide confidence and retrieve tendon flexibility : a good idea is to jog in water!

Stretching and what is called proprioceptive work are necessary before returning to any physical activity.

Returning to sport

Return to sport is allowed after correction of the etiological factors, the possible use of an orthopaedic insole, and a gradual return as part of a sport rehabilitation program.

Relapses are exceptional, although the fear remains

Recovery time: depending on the type of care, +/- 6 months.

Conclusion

The Achilles tendon rupture is an unpredictable accident that may affect any athlete without any warning signs.

Docteur Patrick Bacquaert

Médecin chef de l'IRBMS

  • 1
  • 2
  • 3
  • 4
  • 5
Vote
£4.99*
4.21 / 5 42 ratings
    Advice

    Achilles tendinitis is an inflammation of the tendon including all pains in the Achilles tendon. It commonly affects all athletes, but most particularly runners and joggers, usually resulting from a too high training volume and aggravated by micro-traumas due to shoe-ground interface.

    (6)
    TOP OF PAGE