Achilles Tendon Rupture (Acute Achilles tendon rupture) — Confirmation of Medical Term
Achilles tendon rupture is the medically accurate name of the condition. English name: Acute Achilles tendon rupture.
1) Condition Description (Causes and Symptoms)
- Definition: A condition in which the tendon of the calf muscles responsible for plantar flexion (the Achilles tendon) is partially or completely torn. It commonly occurs 2–6 cm above the heel, where blood flow is relatively poor.
- Main causes
- Acute trauma occurring during recreational or strenuous exercise (rapid jumping and landing, changes in direction)
- Chronic tendon degeneration (increasing age, repeated microtrauma)
- Risk factors: repeated steroid injections or systemic steroid use, use of fluoroquinolone antibiotics, rheumatic diseases, thyroid abnormalities, gout, smoking, diabetes
- Pathophysiology: Acute discontinuity of the tendon fibers interrupts force transmission, causing loss of plantar-flexion strength; the proximal calf muscles are retracted, creating a depression at the rupture site.
- Typical symptoms
- Pain occurring with a sudden “pop” or “snap” sound
- Initial pain may improve, but standing on tiptoes (plantar flexion) is impossible or weakened
- A depression (dimple) and tenderness at the rupture site, with weakness of the calf muscles
- Walking may be possible, but standing on tiptoes is impossible
- Diagnostic clues: A positive Thompson test (loss of plantar flexion when the calf is squeezed); ultrasound or MRI can determine the extent of the rupture.
2) Treatment Methods
- Initial first aid
- RICE (rest/ice/compression/elevation), immobilization (cast or splint), pain medication, and non-weight-bearing (crutches)
- Early evaluation by an orthopedic specialist is recommended
- Confirmatory tests
- Evidence-based tests: ultrasound (rapid and cost-effective), MRI (evaluation of partial tears and associated lesions)
- Conservative treatment
- Indications: older patients or patients at high risk for surgery, and small partial tears
- Method: Maintain the foot in plantar flexion (heel elevated) using a functional brace (walking boot), gradually expand the range of extension, and gradually allow weight-bearing
- Duration: Generally immobilization and rehabilitation for at least 6–8 weeks (varies according to the protocol)
- Advantages: Avoidance of surgical complications; disadvantage: some studies indicate a possible increase in the re-rupture rate (recent functional conservative treatment has improved outcomes)
- Surgical treatment
- Indications: highly active patients, complete rupture, inability to approximate the proximal and distal ends, re-rupture, or chronic rupture
- Methods: open repair, percutaneous repair (reduced skin complications), and reconstruction (tendon grafting or transfer for severe defects)
- Advantages: Lower re-rupture rate (in traditional comparisons); disadvantages: risk of wound infection, skin problems, and nerve damage (e.g., sural nerve)
- Rehabilitation
- Both surgical and nonsurgical treatment require gradual weight-bearing and ROM exercises, strengthening, and balance training
- Return to sports: Usually 4–6 months; high-intensity exercise may be delayed for up to 6–12 months
- Medication and other measures
- Pain management: NSAIDs and, if necessary, short-term opioids
- Prophylactic antibiotics during surgery (according to the recommended protocol)
- Precautions (during and after treatment)
- Avoid strenuous joint movement and weight-bearing during the early stage of treatment
- Local steroid injections and recent fluoroquinolone use increase the risk of tendon damage — inform the medical staff
- Smoking and poor blood sugar control may delay healing
- Complications
- Re-rupture, wound infection, nerve damage (sensory abnormalities), thrombosis (deep vein thrombosis), and long-term weakness or reduced exercise capacity
- Prognosis
- After appropriate treatment and rehabilitation, many patients can return to walking and daily activities. Exercise capacity varies by individual (return to high-intensity sports may be limited in some cases).
3) Checklist Before an Outpatient Visit (Items to Bring, Information to Tell the Doctor, and Example Questions)
- Items to bring
- List of currently taken medications (be sure to include whether you use steroids, anticoagulants, or fluoroquinolones)
- Medical history (rheumatic diseases, diabetes, thyroid disease, etc.)
- Details of the injury (when and how it occurred, and how the pain developed) and photographs (if there is swelling or skin change)
- Previous test results (X-rays, ultrasound, or MRI images, if available)
- Items you can check yourself before the appointment
- Whether you can stand on tiptoes (possible/impossible), pain intensity (numeric pain scale), and walking status (whether crutches are being used)
- Examples of questions you may answer in advance during the appointment (in preparation for the treating doctor’s questions)
- The exact mechanism of injury (jumping, changing direction, falling, etc.)
- Changes in pain and swelling or bruising (how long they have lasted since onset)
- Whether you previously had pain or injections involving the affected ankle or tendon
4) Examples of General Questions to Ask the Doctor
- What tests are needed to confirm this condition? (Need for ultrasound or MRI)
- Which is more suitable for me, surgery or conservative treatment? What are the advantages and disadvantages?
- What is the expected recovery period and rehabilitation plan? When can I begin weight-bearing and exercise?
- What complications are expected with surgery, and what is the approximate risk of re-rupture?
- How will pain be managed? What medications or physical therapy are recommended?
5) Examples of Condition-Specific Questions
- In my case (briefly explaining my age, activity level, and underlying conditions), is surgery absolutely necessary, or would conservative treatment be sufficient?
- What specific exercise and lifestyle precautions should I follow after surgery and during conservative treatment to reduce the risk of re-rupture?
(During the appointment, accurately providing information about your medications and underlying conditions is important for diagnosis and treatment selection.)