Achilles Ruptures

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Thompson Test
Tendon Repair

The Achilles tendon is the attachment of the calf muscle complex to the heel. The calf muscle complex is composed of the Gastrocnemius and Soleus Muscles. The Gastrocnemius is above and on top of the Soleus.

The Achilles Tendon was named for the mightiest Greek mortal to fight in the Trojan War. As the myth goes, Achilles was mortally wounded by Alexander, aided by Apollo, by shooting an arrow into Achilles’ heel. Thus we are given the metaphor “Achilles Heel.”

The Achilles attachment on the heel allows the calf muscle complex to extend the ankle joint. This results in the force needed to walk, run, and jump.

Most Achilles ruptures happen when sudden changes occur in direction or force. A specific example is a quarterback dropping back to pass or a tennis player rushing to the net and then retreats explosively for a lob.

When the Achilles ruptures the athlete may feel a “pop” or “snap” in the back of the lower leg. They also may say “I feel like I’ve been shot.” The athlete will feel some weakness while walking, pain, and swelling.

This graphic shows a tendon rupture just above the Achilles attachment at the calcaneus. Many times the tendon will not tear completely, as the graphic shows, but will partially tear. With a partial tear, some of the tendon fibers will remain intact. This will give the athlete the perception that they have not suffered a major injury. Unless a very small portion of the tendons is torn, with the majority of the fibers left intact, the injury will necessitate surgery to repair the damage.

To properly diagnose a torn Achilles, a proper history is a must. The clinician must look for signs about previous tendinitis, pain, strains, or calf muscle injuries. The clinician should also be aware of previous corticosteroid and anabolic steroid use.

One predisposing factor for Achilles tears is Achilles Tendinitis. Tendinitis will cause a weak spot in the tendon where scar tissue has replaced normal tendon tissue. This becomes the weak link in the tendon, allowing for a tear to occur.

A functional test for Achilles tendon tears is called the Thompson test. The athlete is positioned on their stomach with the foot hanging loosely off of the end of the table. The clinician then squeezes the belly of the calf to see if it points the toe. If the foot does not move, it is considered a positive test for a torn tendon. The graphic shows a positive test, note the depression between the arrows.

As a side note, ruptures are more rare in adolescents than they are in adults. The incidence of Achilles Tendon tears goes up dramatically (nearly 3 times higher likelihood) in men over the age of 40. Researchers are not completely sure of the reason for this dramatic increase in Achilles Tendon tears. Other factors in this age group are gout and hyperparathyroidism.

Repair of a ruptured Achilles tendon is very straight forward. The skin around the tear is opened, the tear is visualized, and repaired. The torn ends are woven back together with dissolvable sutures. The long blue strands seen in the picture are the sutures used to weave the tendon ends back together.

The skin is then sewn back together and the athlete is placed in a post-operative dressing. The athlete will be non-weight bearing for a period of 3 to 6 weeks, depending upon the conservativeness of the surgeon.

Some physicians will use serial casting to gradually lengthen the tendon during the repair process. Others will rely on rehabilitation exercises to facilitate the lengthening of the tendon.

Rehabilitation exercises will be instituted within 2 to 6 weeks post-op, again depending on the physician.

The early goals of rehabilitation should be:

  • Decrease Pain,

  • Decrease Swelling, and

  • Gently Increase Range of Motion.

Rehabilitation should progress, as the physician allows, to include:

  • Range of Motion Increases,

  • Strength Increases,

  • Return of Normal Proprioception,

  • Return of Normal Coordination,

  • Proper Gait Training,

  • Proper Jogging Mechanics,

  • Proper Running Mechanics,

  • Proper Jumping Mechanics, and

  • Return to Sport Activities.

With proper recognition and treatment of this injury, the athlete should return to normal athletic activities. After this type of injury, proper warm-up and continued conditioning need to be a priority of the athlete.



©2000 - 2009 David Edell

Information on this site is not a substitute for physician directed care.

Please consult your personal physician for more detailed information

concerning specific injuries or illnesses.

Last Update for 10/24/2009 12:09:35 AM