Achilles tendon tear

Achilles tendon tear: What’s that?

The Achilles tendon is the strongest tendon in the body. It connects the calf muscle (M. Triceps Surae) and the foot (heel bone). This connection enables lowering of the foot. If this tendon is torn or partially torn, we speak of an Achilles tendon tear or an Achilles tendon rupture. In this case, lowering the foot against resistance is no longer possible or only with pain.

Some 15,000-20,000 Achilles tendon ruptures are registered in Germany per year. Here, the peak age amongst adults is between 30 and 50 years old. It is conspicuous that males are more frequently affected than females (5:1)¹.

Often, the Achilles tendon tears at its narrowest point, the so-called Achilles tendon waistline, which is located approx. 3-5 cm above the heel bone.

By the way, the Achilles tendon was named with reference to Greek mythology. According to Greek legend, Achilleus was invulnerable in combat with the exception of one small point on his heel, where he was finally wounded and died in combat.

Causes of an Achilles tendon tear

An Achilles tendon tear does not arise as so often suspected via external trauma. Rather, already existing microtraumas or sudden, abrupt movements are causal. Most Achilles tendon ruptures are incurred during sports. That also explains the peak age of 30 to 50 years old. In particular during sports, fast movement changes often take place in conjunction with heavy burdens. If the Achilles tendon is insufficiently stretched and untrained or if it already displays micro-fissures, it is possible that it is torn (or rips → partial rupture). Also, metabolic disorders or a long-term cortisone therapy may exercise negative effects on the state of the Achilles tendon.

The so-called “weekend warrior” who mostly engages in sports activities at the weekend and happily overburdens him/herself is a typical patient.

Symptoms of an Achilles tendon tear

Often, the Achilles tendon tears with a characteristic whip crack, followed by pain in the calf or heel region. Also, a swelling and haematomas can occur in the rupture region.

Restricted freedom of movement of the foot affected is typical for a tear of the Achilles tendon, because the calf muscles no longer have a root (connection) on the foot. With this, the muscle strength can no longer be transferred to the heel bone.

Diagnosis of an Achilles tendon tear

It is relatively easy for a trained examiner to diagnose an Achilles tendon tear. In addition to case history (details of how the accident occurred) and an examination of the body, normally an “indent” of the tendon in the region of the tear can be identified by touch. Restricted freedom of movement can be examined using various tests:

• Rising onto the tips of the toes → on the side affected no longer possible
• Thompson test → Test for the assessment of the calf muscle reflex

Use an ultrasound examination or MRI to determine the exact tear position.

Therapy for an Achilles tendon tear

The therapy depends on the extent of the Achilles tendon rupture. At the same time, it is assessed how far the ends of the tendons have been separated (rupture or partial rupture). The physician can check this with an ultrasound device.

If the Achilles tendon is only partially ruptured (partially torn) or the torn parts of the tendons are close together, the treating physician can decide in favour of conservative therapy (treatment without an operation). Here, a special lower leg foot brace such as the BORT X-Walker Achillo is used. Depending on the therapy plan, the foot is immobilised in this brace in a specified position for several weeks. Often, positioning of the foot in 20° plantar flexion (equinus position) is used. This position relieves the Achilles tendon and supports the approach and joining process of the ruptured parts of the tendon.

If the ruptured parts of the tendon are widespread or displaced, mostly operative therapy is considered. Here, dependent on the operation technique, the separated ends are joined again. Also after the operation a lower leg foot brace such as the BORT X-Walker Achillo is used in equinus position.

Accompanying rehabilitation can help to regain the full scope of movement.

Depending on the extent of the rupture and the therapy plan from the treating physician, it can take several months until the Achilles tendon can again be fully burdened (e.g. for sports)

How can Achilles tendon tears be prevented?

As most Achilles tendon ruptures are incurred during the course of sports activities, you should always keep your body in good physical shape. In particular, untrained persons should avoid fast or sudden burdens.

Special exercises such as the BORT Achilles tendon exercises (german version) can help to strengthen the Achilles tendon. Also, stretching exercises and warming-up, primarily prior to sports, can support prevention.