First, a tendon connects a bone to a muscle. The Achilles Tendon connects the heel bone to the calf muscle.
A ruptured tendon causes severe pain and an inability to press the foot down;Like when pressing down on the gas pedal.
Quickcare or ER?
Most Achilles Tendon ruptures may be treated in the clinic setting. However,
a key red flag is severe pain. It may require narcotics which are, in many areas, given only in the ER.
However, the vast majority can be seen in the clinic and referred to the specialist later.
What will your doctor ask?
Your doctor will want to know your symptoms. A SYMPTOM is your description of your condition to your doctor. It is your story.
What happened before the pain started? A typical story is from sprinting, or a slip and fall
What is the pain like? That is, is it sharp, dull, throbbing?
Where on the lower leg is the pain? Is it the front, back or the side.
What makes the pain better?
What makes the pain worse? Achilles pain hurts when moving the foot down like stepping on the gas pedal.
Do you have any open wounds associated with it?
What will your doctor ask?
Your doctor will look for objective findings during the examination
The doctor needs to know if you have an Achilles rupture or whether it is just inflamed in the case of Achilles tendinitis. Knowing the extent of the Achilles injury is key. A good foot and ankle exam is warranted.
- With either case, the patient will walk flat-footed. Why? Because every time he/she tries to bend his foot to push down to walk fast or run, it will cause a severe pain in the back of the leg.
- The location of the pain is very important.
- As part of the examination, a doctor should touch the tendon A ruptured Achilles tendon will have a little step-off or indenture.
- Then the doctor make the patient lay down on his belly with his bad foot in the air. Once the calf is squeezed, the foot flexes down (See video of Thompson test below). If the tendon is ruptured, the foot does not move.
What is you doctor thinking?
Your doctor will create a mental list of possible reasons for your signs and symptoms. This list is called a differential diagnosis.
Most pertinent is the cause of the pain. It could be the heel that is inflamed. The Achilles tendon may have a inflamed which is a “tendonitis.” Or there could be a complete tear which is a rupture. Again, the Thompson test is key
Always in the back of the head is the possibility of an ankle or leg fracture. A foot fracture to consider is a Lisfranc injury.
Another feature to remember is heel fracture.
What is the treatment of a Ruptured Achilles Tendon?
If it is a tendonitis, then usually anti-inflammatories such as Motrin or Naproxen will help.
If it is ruptured, then a consult with an orthopaedic surgeon or foot doctor (Podiatrist) is needed for a surgical repair.
How long will you be sick?
If the pain is due to a pulled muscle or an inflamed tendon, 1-2 weeks should be enough time for it to heal. If it does not improve, physical therapy may be necessary.
If it is a ruptured Achilles tendon, you can guess there will be a 6-8 week recovery time after surgery.
Let me tell you a story about an Achilles tendon rupture.
Seems like overnight, he became middle aged. First the belly grew and then the hair fell out. Overnight
people couldn’t tell the difference between him and his Uncle Jesse.
The weekend came and some young punks challenged “the old man” to some pick-up soccer (football). His machismo could not keep him away from a challenge. He felt like he still had “it.” “This dog still has a fight!!” Grrr!
It started with gusto. 100% sprints. Raul’s comb-over hair bounced up and down with every sprint. He felt like Pele or Diego Maradona.
Finally,”OOOOOOHHH”. He felt a pull on the back of his foot. He limped to the sidelines and eventually hobbled home to his recliner chair.
“What happened? Did I break something? Did I tear a muscle?” he thought.
In the case of Raul, the pain was local, sharp, constant and worse with movement. He had difficulty walking.
Raul did not show up to the clinic for 3 days after the accident. That is typical. Raul thought it was going to “go away”. He walked in flat-footed.
His exam showed a positive Thompson sign. The Achille’s had an indentation typical of a rupture.
I felt sad when I told him that he would need Achilles tendon surgery. He had just bought some new cleats.
I hope this helps