What is an Achilles Tendon Tear and How Is It Treated?

What is an Achilles Tendon Tear and How  Is It Treated? Blog  Achilles Tendon Tear

Achilles Tendon Tear Basics

This is one of the most common ankle tendon injuries. It occurs frequently in sports-related injuries with it being common in basketball. This type of injury is predominant amongst adult males between the ages of 30-50. Tears most often occur around two inches from where it connects to the heel bone. Blood flow is limited to this area and affects the area’s healing ability.

Evidence of an Achilles Tendon Tear

If an Achilles tendon tear occurs, there may be a popping sound that occurs when the foot is flexed backwards at the time of the injury. This will be accompanied by severe pain in the back of the ankle and up the lower legs. This pain will occur immediately upon injury. Swelling may also occur. Depending on the severity of the rupture, movement may be limited when trying to extend the foot downward.

Factors Contributing to an Achilles Tendon Rupture

Even though many individuals experiencing this injury have not suffered from previous pain stemming from the Achilles tendon, there are predisposing factors that may lead to a tear. A tendon rupture may occur due to these factors other than an injury:

  • Diabetes mellitus
  • Gout
  • Repeated trauma
  • Rheumatoid arthritis
  • Use of certain antibiotics
  • Hyperparathyroidism

These factors may increase the probability of tearing along with leading to a tear apart from injury.

Severity of a Tear

Tearing can range from minor to severe, depending on how much tearing has taken place. In other words, the tear can either be partial or complete. Minor tears can occur over time, which may lead to more severe damage. An acute tear, a singular instance of injury, may also occur. The tear may be interstitial, which means that it is limited to the same fibers of tendon. The severity of the tear is determined by the limitation of movement when trying to flex the foot. A complete tear will be felt and will limit mobility.

Determining if an Achilles Tendon Rupture Has Occurred

There are several methods for determining if a tear has occurred. Plain radiography may be used to view swelling and damage to fat pad, but more intense radiography will be needed to view the Achilles tendon. More often, an MRI is ordered to determine the extent of the rupture. A tear usually presents in an MRI as a gap in the tendon. Retraction of the tendon ends may be visible in a severe rupture. In addition to an MRI, ultrasound may be used as it will detail the change in the topography of the tendon that may include shadowing within the area of the tear.

Treatment

Treatment methods for a tear in the Achilles tendon vary depending upon the extent of the injury. A partial tear may only require non-surgical methods for treatment. More severe ruptures may require surgery to repair the damage. The application of cast to immobilize the injured tendon may also be prescribed. This alternative is usually reserved for those individuals for which surgery is ill-advised.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

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Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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