What Is an Achilles Tendon Tear?
The achilles tendon is a fairly large tendon on the back of the ankle and serves as the connection for the calf muscles (gastrocnemius and soleus) to the calcaneus (heel bone). This tendon is very important for normal activities including walking effectively and certainly in running and jumping. Unfortunately, there is an area of the tendon that has been found to be most prone to injury due to a delicate blood supply. This area is known as a "watershed" area that due to its limited blood supply, and this is where it can degenerate over time. With this tissue breakdown over time, injuries are more likely to occur.
The most common type of injury to this area is a tear in the tendon (called an achilles tendon tear) with running, jumping, and landing activity. This classically occurs with eccentric loading of the muscle in middle age men playing sports on an intermittent basis. Eccentric loading refers to an attempt to contract the muscle as it is being lengthened. This is common in jumping sports and taking a misstep while climbing stairs.
Many people who have an achilles tendon tear feel a distinct sharp pain in the back of the lower leg, near the ankle, often associated with a pop or snap and a burning sensation. With a complete tear, the muscle will not be able to function normally and walking becomes difficult, even if the pain resolves. Partial tears will often allow for near normal muscle function but will continue to be painful until healed.
The diagnosis of the injury is made by a careful physical examination to assess the integrity of the muscle-tendon interface and function as well as palpating (feeling) for any gap in the tendon, which is commonly easy to feel. An MRI is useful to obtain to determine the extent of the tear, amount of retraction of the tendon and the integrity of the remaining tendon. This will often provide information to make a decision on treatment and prognosis.
The treatment for incomplete or partial tears and rarely complete tears is temporary immobilization to allow the body to heal the tendon by forming scar tissue. The treatment for complete achilles tendon tears is typically a surgical repair of the tendon. Several techniques have been described and depending on the type of tear, some techniques are preferred over others. The outcomes for surgical repair are typically quite good and provide a return to sports, but the full recovery can take up to 1 year. Surgical repair has demonstrated a lower risk of rerupture or re-tearing of the tendon as compared to temporary immobilization without surgery. The primary risk of the surgery is a complication associated with the incision, such as infection or wound breakdown, however fortunately these are rare.