Achilles tendon rupture
Pain in the heel[3]
Sudden[3]
Forced plantar flexion of the foot, direct trauma, long-standing tendonitis[4]
Fluoroquinolones, significant change in exercise, rheumatoid arthritis, gout, corticosteroids[1][5]
Based on symptoms and examination, supported by medical imaging[5]
1 per 10,000 people per year[5]
Rupture typically occurs as a result of a sudden bending up of the foot when the calf muscle is engaged, direct trauma, or long-standing tendonitis.[4][5] Other risk factors include the use of fluoroquinolones, a significant change in exercise, rheumatoid arthritis, gout, or corticosteroid use.[1][5] Diagnosis is typically based on symptoms and examination and supported by medical imaging.[5]
Prevention may include stretching before activity and gradual progression of exercise intensity.[4] Treatment may consist of surgical repair or conservative management.[6][2] Quick return to weight bearing (within 4 weeks) appears okay and is often recommended.[6][7] While surgery traditionally results in a small decrease in the risk of re-rupture, the risk of other complications is greater.[2] Non surgical treatment is an alternative as there are supporting evidences that rerupture rates and satisfactory outcomes are comparable to surgery.[2] If appropriate treatment does not occur within 4 weeks of the injury outcomes are not as good.[8]
Achilles tendon rupture occurs in about 1 per 10,000 people per year.[5] Males are more commonly affected than females.[1] People in their 30s to 50s are most commonly affected.[5]
Signs and symptoms[edit]
The main symptom of an Achilles tendon rupture is the sudden onset of sharp pain in the heel. Additionally, a snap or "pop" may be heard as the tendon breaks. Some people describe the pain as a hit or kick behind the lower leg. There is difficulty walking immediately. It may be difficult to push off or stand on the toes of the injured leg. Swelling may be present around the heel.[4]
Causes[edit]
The Achilles tendon is most often injured by sudden downward or upward movement of the foot, or by forced upward flexion of the foot outside its normal range of motion.[9] Other ways the Achilles tendon can be torn involve sudden direct trauma or damage to the tendon, or sudden use of the Achilles after prolonged periods of inactivity, such as bed rest or leg injury. Some other common tears can happen from intense sports overuse. Twisting or jerking motions can also contribute to injury.[4] Some antibiotics, such as levofloxacin, may increase the risk of tendon injury or rupture. These antibiotics are known as Fluoroquinolones.[10] As of 2016 the mechanism through which quinolones cause this was unclear.[10]
Many people may develop an Achilles rupture or tear, such as recreational athletes, older people, or those with a previous Achilles tendon injury. Tendon injections, quinolone use, and extreme changes in exercise intensity can contribute.[4] Most cases of Achilles tendon rupture are traumatic sports injuries. The average age of patients is 29–40 years with a male-to-female ratio of nearly 20:1. Yet, recent studies have shown that Achilles tendon ruptures are rising in all ages up to 60 years of age. It has been theorized that this is due to the popularity of remaining active with older age.[11] Additionally, even the occasional weekend exercise activity for "weekend warriors" may put one at risk. The risk continues to be higher in people who are older than 60, and also taking corticosteroids, or have kidney disease. Risk also increases with dose amount and for longer periods of time.[11]
Epidemiology[edit]
Of all the large tendon ruptures, 1 in 5 will be an Achilles tendon rupture. An Achilles tendon rupture is estimated to occur in a little over 1 per 10,000 people per year. Males are also over 2 times more likely to develop an Achilles tendon rupture as opposed to women. Achilles tendon rupture tends to occur most frequently between the ages of 25-40 and over 60 years of age. Sports and high-impact activity is the most common cause of rupture in younger people, whereas sudden rupture from chronic tendon damage is more common in older people.[25] The rate of return to sports in the months or years following the rupture (whether operated on or not, partial or total) is 70 to 80%.[26]
