Individuals who participate in physical and sports activities could suffer an Achilles tendon tear. Can understanding the symptoms and risks help in treatment and return the individual back to their sports activity sooner?

Achilles Tendon

This is a common injury that occurs when the tendon attaching the calf muscle to the heel gets torn.

About the Tendon

• The Achilles tendon is the largest tendon in the body.
• In sports and physical activities, intense explosive movements like running, sprinting, quickly shifting positions, and jumping are exerted on the Achilles.
• Males are more likely to tear their Achilles and sustain a tendon rupture. (G. Thevendran et al., 2013)
• The injury often occurs without any contact or collision but rather the running, starting, stopping, and pulling actions placed on the feet.
• Certain antibiotics and cortisone shots can increase the likelihood of Achilles tear injuries.
• A specific antibiotic, fluoroquinolones, has been shown to increase the risk of Achilles tendon problems.
• Cortisone shots are also associated with Achilles tears, which is why many healthcare providers don’t recommend cortisone for Achilles tendonitis. (Anne L. Stephenson et al., 2013)

Symptoms

• A tendon tear or rupture causes sudden pain behind the ankle.
• Individuals may hear a pop or a snap and often report the feeling as being kicked in the calf or heel.
• Individuals have difficulty pointing their toes downward.
• Individuals may have swelling and bruising around the tendon.
• A healthcare provider will examine the ankle for continuity of the tendon.
• Squeezing the calf muscle is supposed to cause the foot to point downwards, but in individuals with a tear, the foot will not move, resulting in positive results on the Thompson test.
• A defect in the tendon can usually be felt after a tear.
• X-rays may be used to rule out other conditions, including ankle fracture or ankle arthritis.

Risk Factors

• Achilles tendon ruptures are most seen in men around 30 or 40. (David Pedowitz, Greg Kirwan. 2013)
• Many individuals have symptoms of tendonitis prior to sustaining a tear.
• The majority of individuals have no history of previous Achilles tendon problems.
• The majority of Achilles tendon tears are associated with ball sports. (Youichi Yasui et al., 2017)

Other risk factors include:

• Gout
• Cortisone injections into the Achilles tendon
• Fluoroquinolone antibiotic use

Fluoroquinolone antibiotics are commonly used for the treatment of respiratory infections, urinary tract infections, and bacterial infections. These antibiotics are associated with Achilles tendon rupture, but further research is needed to determine how they affect the Achilles tendon. Individuals taking these medications are advised to consider an alternative medication if Achilles tendon problems begin to develop. (Anne L. Stephenson et al., 2013)

Treatment

Depending on the severity of the injury, treatment can consist of non-surgical techniques or surgery.

• The benefit of surgery is there is usually less immobilization.
• Individuals can often return to sports activities sooner, and there is less chance of re-rupturing the tendon.
• Non-surgical treatment avoids the potential surgical risks, and the long-term functional results are similar. (David Pedowitz, Greg Kirwan. 2013)

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Treating Ankle Sprains

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References

Thevendran, G., Sarraf, K. M., Patel, N. K., Sadri, A., & Rosenfeld, P. (2013). The ruptured Achilles tendon: a current overview from biology of rupture to treatment. Musculoskeletal surgery, 97(1), 9–20. doi.org/10.1007/s12306-013-0251-6

Stephenson, A. L., Wu, W., Cortes, D., & Rochon, P. A. (2013). Tendon Injury and Fluoroquinolone Use: A Systematic Review. Drug safety, 36(9), 709–721. doi.org/10.1007/s40264-013-0089-8

Pedowitz, D., & Kirwan, G. (2013). Achilles tendon ruptures. Current reviews in musculoskeletal medicine, 6(4), 285–293. doi.org/10.1007/s12178-013-9185-8

Yasui, Y., Tonogai, I., Rosenbaum, A. J., Shimozono, Y., Kawano, H., & Kennedy, J. G. (2017). The Risk of Achilles Tendon Rupture in the Patients with Achilles Tendinopathy: Healthcare Database Analysis in the United States. BioMed research international, 2017, 7021862. doi.org/10.1155/2017/7021862