The Achilles tendon is located in the back of the heel, connecting the calf muscle to the heel bone. It is the largest and strongest tendon in the body because it sees the largest forces in the body. Its role is to push down the ball of the foot such as pressing on a gas pedal or standing on tiptoes. You use it daily to walk, run, climb stairs and jump.
Achilles tendon ruptures usually happen in people who are involved in sports or activities that require explosive movements like jumping or running, typically when the foot transitions from being in a dorsiflexed (foot up) position to pushing off and bringing the foot into a plantarflexed (foot down) position. A tear may also occur due to a direct blow or cut to the tendon itself.
Certain factors may increase the risk of Achilles tendon tears, such as use of oral steroids or use of fluoroquinolone antibiotics (Levaquin, Cipro). These medications generally place tendons at a higher risk of rupture. Prior steroid injections into the tendon may weaken the tendon as well. People who are relatively inactive during the week and then are extremely active during the weekends (weekend warriors) have an especially higher risk.
At the time of the injury, many patients report hearing or feeling a pop and/or feeling like they were kicked at the back of the ankle. The area around the back of the ankle may become bruised and swollen. While some people feel significant pain and inability to walk, some people may surprisingly feel only minimal pain and only minor difficulty moving their foot. This may be dependent on the extent of the injury, or whether it is a partial or complete rupture. In a complete rupture, most patients will not be able to push off with the affected leg or to stand on the toes with the affected leg.
Because some patients may feel relatively minor symptoms from an Achilles Tendon rupture, a delay in diagnosis and treatment is not uncommon, leading to sub-optimal results. Please do not procrastinate seeing the doctor!
Initial diagnostic workup will include a history and physical exam. An x-ray may be obtained in order to evaluate for any fractures and rule out other diagnoses. Additional workup such as an Ultrasound or MRI imaging may be ordered to characterize the extent of the suspected tear.
The treatment of Achilles tendon tears depends on the extent of the tear as well as the age and activity level of the patient. Partial tears in general no matter what the age is typically treated nonoperatively. If only a small percentage of the tendon is torn, this might entail simply a modification of activities, a heel lift in the shoe, and physical therapy. In high-grade partial tears, Dr. Steven Lee may even decide to place the patient in a Cam Walker (looks like a ski boot!) for up to 6-8 weeks.
Surgical treatment is usually recommended for complete tendon tears, unless the patient is either too old or is medically too infirm to undergo surgery. The procedure typically takes about 20 minutes to do, and involves making an incision near the tendon at the ankle and repairing the tendon by cleaning the torn ends, and then tying the tendon with very strong sutures. This can be done in a minimally invasive way making a relatively small incision. For best results, this should be done within 3 weeks from the time of the injury. Learn more about scheduling surgery.
Dr. Steven Lee is one of the most experienced Orthopedic Surgeons in New York with respect to Achilles tendon tears. He dedicated a number of years researching the Achilles tendon and has written 5 research papers on Achilles Tendons to determine the optimal surgical treatment and fastest rehabilitation and recovery treatments possible.
In general, patients will be placed into a splint immediately after surgery to protect the surgical area and repair. Since the ankle is an area that is more susceptible to infection, patients are often prescribed antibiotics to take for several days. Patients are also advised to take one aspirin (if not contraindicated) to prevent formation of blood clots in the leg. The first post-op visit will occur 7-10 days after surgery in order to check the surgical site and change the splint into a cast.
During the first few weeks, it is extremely important to keep your ankle elevated above the level of your heart to reduce swelling and therefore reduce wound/skin complications. This cannot be stressed enough!
Patients are usually transitioned to a boot at their second post-op visit and started on physical therapy. The operated leg should not be used to bear any weight until at least 3 weeks after surgery. Weight-bearing activities, mobility, and strength will gradually be restored with physical therapy. Patients can expect to improve steadily for up to a year after surgery.
Learn more about post-operative care.
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.