Achilles Tendon Rupture

The Achilles tendon is the large tendon that attaches to the heel. The gastrocnemius and soleus muscles form into the Achilles tendon. Occasionally this tendon may rupture. The usual site of rupture is 2-6 cm above the insertion to the heel (clacaneus). This happens to be the area of least blood supply to the tendon.

Achilles tendon ruptures typically occur in poorly conditioned, middle-aged men who, though still very aggressive in athletics, only participate sporadically (The Weekend Warrior).

The injury usually occurs when landing with the foot dorsiflexed or during push-off, but is occasionally due to direct injury to the tendon. Most people who have had this injury will tell you that they heard or felt a pop. There is usually pain immediately that resolves over a few days. Often, there is swelling and weakness of push off (plantar flex) is noted.  You can often palpate a gap in the tendon. Most people are able to walk with this injury after a few days.

Once the diagnosis is made, the decision regarding treatment must be made. There is some controversy regarding treatment. Casting of the ankle with the foot down (plantarflexion) will allow the tendon to heal. Surgical repair of the tendon will allow increased strength and power compared to cast treatment. There are fewer re-ruptures after surgical repair. As with any surgery there could be complications including infection, wound problems, injury to nerves or scarring of the tendon. We feel that, for active individuals, surgical repair is the best option.

Recently, a young fireman from Bath injured his Achilles tendon while playing in a benefit football game with the New England Patriot's Alumni. He has allowed us to post photos from his surgery.

In this picture of the ruptured tendon, the heel is to the left and the calf is to the right. The white stringy thing is the torn tendon:

This is a photo of the sutures in the top and bottom sections of ruptured tendon. You can see how the ends will meet and be sewn together:

This is a photo of the repaired tendon:

Here is the patient, who was awake and talking throughout the surgery: