Achilles Tendon Rupture- What is it? When and how often does it rupture?
So for Christmas my letter to Santa obviously got lost, that or I have been put on the naughty list because as much as I like sitting down with my feet up at Christmas I didn’t want to do that for 8 weeks with a right Achilles tendon rupture! I am going to write a few short informative posts about my Achilles injury as I go through injury, treatment and rehab.
The Achilles Tendon (AT) is the largest tendon in the body (Mehra et al., 2004) located at the back of your ankle, connecting your calf muscle to your heel (bone) allowing for planta flexion (pointing of the toes to the floor) to occur at the ankle when the calf is contracted. As the bodies largest and strongest tendon it can bear up to 12 times body weight (Maffulli et al., 2003) and is vital in any human locomotion like walking and running. However, it is often the most injured making up for 20% of all large tendon ruptures (Maffulli et al., 2003).
The tendon endures strain and risks rupture from running, jumping, and sudden acceleration or deceleration. So many sports can put this tendon at risk of injury or rupture. A tendon rupture can be partial or full but is usually torn as a result of a large force from muscle contraction or impact (from jumping/falling) and can feel like being kicked in the back of the calf with some people feeling or hearing an audible ‘pop’ or ‘snap’. In my case it was like being hit in the back of the calf with a squash racket with a nerve like pain such as hitting your funny bone. Unfortunately, my squash partner hadn’t decided to hit me in the back of the leg and trip me up, it was my body failing me.
Rupture within the Achilles tendon normally occurs in an area of structural weakness call the water shed area, approx. 2-6 cm from its attachment onto the heel. Mine snapped 5 cm up from the heel insertion. This natural weak point is due to the smallest cross-sectional area of the tendon along its length. The most common cause of Achilles tendon rupture, over 80%, is trauma during recreational sports (Knobloch et al., 2006), most commonly in sports such as football, tennis, badminton, running, volleyball and how I managed to do mine, squash. Basically, any sports with explosive movements but normally more likely to occur for those that are male between 30 and 50 years old (Järvinen et al., 2005) and these are the only real risk factors, that I can logically see, that I would be more likely to sustain this injury. So potentially for me it is really just one of the unfortunate few, or an asymptomatic (unknown, non presenting) underlying weakness/ risk factor which I will talk about in my next post.
Normally individuals who are right-handed, the left Achilles tendon is most likely to rupture and vice versa (Alušík & Paluch, 2018). But in my case it was the same as my dominant side as well and being particularly unlikely to happen with incident rates of rupture of 31 per 100000 per year (Ochen et al., 2019), which if my maths is correct, works out to be 0.03% chance of it occurring in the general population. Although, in some competitive athlete populations tendon rupture prevalence has been reported to be up to 8.3 %. Either way it occurs in and out of sport so isn’t just a sporting injury with its mechanism and risk factors solely in the active population.
There are many other risk factors which would make this injury more likely to occur for certain demographics or populations which I will outline in my next post but if it does occur you are severely incapacitated. As the main tendon of the lower limb it isn’t possible to walk unaffected with the impossibility to raise up on to your toes and creating server discomfort. It happened to me I felt like my calf was all floppy and although it didn’t look too different, no immediate swelling, the muscle had lost its tone. I was certain It was serious but held out hope that it wasn’t a rupture as I knew the severity of an AT rupture.
So in my opinion it’s not an injury you want, a broken bone, a sprain, strain even a torn muscle could potentially be better with a faster recovery, but sometimes you can’t predict when or account for why it has occurred. After all the silly isolated places I have been running by myself I can only really be grateful it happened in a squash court less than half a mile from A&E with people being around to assist. It could always be worse and can only try to move forward with a positive mental attitude.
Bilateral simultaneous spontaneous rupture of the Achilles tendon. Mehra A, Maheshwari R, Case R, Croucher C Hosp Med. 2004 May; 65(5):308-9.
Clinical diagnosis of Achilles tendinopathy with tendinosis. Maffulli N, Kenward MG, Testa V, Capasso G, Regine R, King JB Clin J Sport Med. 2003 Jan; 13(1):11-5.
Achilles tendon and paratendon microcirculation in midportion and insertional tendinopathy in athletes. Knobloch K, Kraemer R, Lichtenberg A, Jagodzinski M, Gossling T, Richter M, Zeichen J, Hufner T, Krettek C. Am J Sports Med. 2006 Jan; 34(1):92-7.
Alušík Š, Paluch Z. [Drug induced tendon injury]. Vnitr Lek. 2018 Winter; 63(12):967-971.
Järvinen TA, Kannus P, Maffulli N, Khan KM. Achilles tendon disorders: etiology and epidemiology. Foot Ankle Clin. 2005 Jun;10(2):255-66)
Yassine Ochen, Reinier B Beks, Mark van Heijl, Falco Hietbrink, Luke P H Leenen, Detlef van der Velde, Marilyn Heng, Olivier van der Meijden, Rolf H H Groenwold, R Marijn Houwert. Operative treatment versus nonoperative treatment of Achilles tendon ruptures: systematic review and meta-analysis. BMJ: first published as 10.1136/bmj.k5120 on 7 January 2019