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Achilles tendon rupture.

Runners can give their Achilles tendon quite a beating if they aren't careful. The Achilles tendon is the largest tendon in the body, connecting the muscles of the lower leg (soleus and gastrocnemius) to the heel bone. Its job is to transfer the force of muscular contractions to lift the heel. Many runners develop Achilles tendonitis, which is inflammation of this tendon.

Although a rupture is not likely to occur during running, explosive movements when your tendon is tight or inflamed can make it happen. You'll hear of a runner getting a rupture during weekend tennis or basketball, or during intensive jump training or speed work. Explosive movements after steroid infections for Achilles tendonitis can make the tendon very vulnerable and weak.

Signs and Symptoms

An Achilles rupture can feel as if someone hit you or threw a rock at your heel. The injury usually occurs at the push-off phase when a great amount of stress is placed on the tendon. The audible "pop" usually accompanies the rupture with pain one to two inches above the heel. The pain can quickly quiet down and you can walk, but with an altered gait. Unable to push-off from the ball of the foot, the foot must be lifted off the ground flat instead of the usual rolling step.

It is impossible to rise up on the ball of the foot with an Achilles tendon rupture because the connection between the muscles and the tendon has been interrupted. If your ankle is only sprained, then a heel raise may be painful, but possible. An MRI can confirm the rupture and the extent of damage.


Inflammation: Achilles tendinitis may predispose a runner to rupture. Inflammation is often due to overtraining or improper training. Some studies show that 20% of rupture victims experienced Achilles tendinitis. Symptoms include pain and stiffness at the back of the heel, especially when taking the first steps after prolonged sitting or first thing in the morning. These symptoms may also occur after cool-down from walking, running, or jumping activities.

Inflexibility: The cumulative effect of the development of leg muscles without adequate stretching and flexibility can set the stage for rupture.

Biome hanics: Certain structural abnormalities and biomechanical errors can predispose a runner to Achilles tendinitis and rupture. Possibilities include worn running shoes with a flattened arch, too much hill running, and being overweight.

RX Measures

* Complete ruptures are typically repaired surgically. You will be in a cast and walk with crutches for several weeks postoperatively. After the cast is removed at about six to eight weeks after surgery, a heel-lifted boot, which is gradually lowered, is used to protect the repair.

* Incomplete ruptures are usually treated with rest, limited weight bearing with crutches, a great deal of stretching, and a heel lift. Sometimes a cast is used to hold the foot in a plantar flexed position (slightly pointed down) to take the stress off the tendon. Non-operative treatment may not be a realistic option for athletic individuals.

* Rehabilitation is a long and arduous process best done under the supervision of a physical therapist. Physical therapy begins about six weeks after surgery. Therapy involves gentle stretching, strengthening, balance, and sport-specific agility activities. A gradual progression into explosive activities is essential.

* Before returning to running, underwater treadmill work is useful for strengthening, range of motion, and balance.

* Overall, you can expect to return to running six to nine months after surgery. It may take as much as a year to heal and recover fully.

To Avoid Future Problems

* Prevention by attending to lesser Achilles tendon problems is key to avoiding the misery of rehabilitation and months of forced time off from running. Include stretching and strengthening in your regular training regimen to prevent problems.

* Care for Achilles tendon problems early. Treatment includes Rest, Ice, Compression, and Elevation and a training evaluation to determine the possible training errors causing the inflammation. Avoid treatment with cortisone injections. It can mask warning pain, weaken the tendon, and predispose the tendon to full rupture.

* Avoid overtraining by allowing adequate time for recovery. Pay attention to pain that doesn't go away with a day of rest and pain that increases rather than decreases with use. Too much hillwork, too much speedwork, inadequate stretching and inadequate recovery can set the stage for Achilles tendon rupture.

* Wearing high heels all day then shifting to flat running shoes can put extra strain on the Achilles tendon, Choose flatter shoes for work.

(Easton Germain, M.P.T., of Metro Orthopedics and Sports Therapy, Washington, D.C. contributed to this article)

RELATED ARTICLE: Achilles tendon rupture The tendon connecting the calf muscles and the foot is completely severed.

Related Conditions Achilles tendinitis, Achilles tendinosis, ankle strains, ankle sprains

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Publication:Running & FitNews
Article Type:Brief Article
Date:Nov 1, 1999
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