Is Achilles Tendon Rupture Painful

Overview

An Achilles tendon rupture is when part or all of your tendon is torn. The Achilles tendon connects the calf muscle in your lower leg to your heel bone. It allows you to point your foot down and to rise on your toes. A tear is caused by an injury or increased pressure, such as during sports or a fall. The following may make your Achilles tendon weak or stiff, and more likely to tear. A past tendon tear. Lack of physical activity. Abnormal bone structure in your foot. Obesity. Older age. Medicines, such as steroids and antibiotics.

Causes
Factors that may increase your risk of Achilles tendon rupture include some of the following. Age. The peak age for Achilles tendon rupture is 30 to 40. Sex. Achilles tendon rupture is up to five times more likely to occur in men than in women. Recreational sports. Achilles tendon injuries occur more often during sports that involve running, jumping, and sudden starts and stops, such as soccer, basketball and tennis. Steroid injections. Doctors sometimes inject steroids into an ankle joint to reduce pain and inflammation. However, this medication can weaken nearby tendons fitness and weight loss guide has been associated with Achilles tendon ruptures. Certain antibiotics. Fluoroquinolone antibiotics, such as ciprofloxacin (Cipro) or levofloxacin (Levaquin), increase the risk of Achilles tendon rupture.

Symptoms
Symptoms include a sudden sharp pain in the achilles tendon which is often described as if being physically struck by an object or implement. A loud snapping noise or bang may also be heard at the time. A gap of 4 to 5 cm in the tendon can be felt which may be less obvious later as swelling increases. After a short while the athlete may be able to walk again but without the power to push off with the foot. There will be a significant loss of strength in the injured leg and the patient will be unable to stand on tip toes. There may be considerable swelling around the achilles tendon and a positive result for Thompson's test can help confirm the diagnosis.

Diagnosis
A detailed history, and examination by an appropriately qualified health professional, will allow a diagnosis to be made. An ultrasound or MRI scan can confirm the diagnosis. Other causes of symptoms in the area, such as those referred from the lumbar spine and local infection, should be excluded.

Non Surgical Treatment
Achilles tendon ruptures can be treated non-operatively or operatively. Both of these treatment approaches have advantages and disadvantages. In general, younger patients with no medical problems may tend to do better with operative treatment, whereas patients with significant medical problems or older age may be best served with non-operative treatment. However, the decision of how the Achilles tendon rupture is treated should be based on each individual patient after the advantages and disadvantages of both treatment options are reviewed. It is important to realize that while Achilles tendon ruptures can be treated either non-operatively or operatively, they must be treated. A neglected Achilles tendon rupture (i.e. one where the tendon ends are not kept opposed) will lead to marked problems of the leg in walking, which may eventually lead to other limb and joint problems. Furthermore, late reconstruction of non-treated Achilles tendon rupture is significantly more complex than timely treatment.


Surgical Treatment
While it is possible to treat an Achilles tendon rupture without surgery, this is not ideal since the maximum strength of the muscle and tendon rarely returns. The reason is the ends of the tendon are ruptured in a very irregular manner, almost like the ends of a paint brush. As soon as the tendon ruptures, the calf muscle (gastrocnemius muscle) continues to pull on the tendon and the end of the ruptured tendon pulls back into the leg, which is called retraction. Once the tendon retracts, it is never possible to get sufficient strength back without surgery, because the muscle no longer functions at the correct biomechanical length and is now stretched out. There are patients for whom surgery cannot be performed, in particular, due to existing medical conditions that may add to potential for complications following surgery. For these patients, a specially designed boot that positions the foot correctly and takes the pressure and tension off the muscle and tendon is used. Most importantly, a cast is never used because it causes permanent shrinkage (atrophy) of the calf muscle. The special boot permits pressure on the foot with walking. The boot also has a hinge to permit movement of the ankle. Many studies of Achilles tendon ruptures have shown that this movement of the foot in the boot while walking is ideal for tendon healing. If surgery is not recommended, it is essential to obtain special tests to check that the ends of the tendon are lying next to each other so that healing can occur. The best test to do this is an ultrasound and not an MRI.

Prevention
The best treatment of Achilles tendonitis is prevention. Stretching the Achilles tendon before exercise, even at the start of the day, will help to maintain ankle flexibility. Problems with foot mechanics can also lead to Achilles tendonitis. This can often be treated with devices inserted into the shoes such as heel cups, arch supports, and custom orthotics.