Overview The Achilles tendon is situated above the heel and forms the lower part of the calf muscles. It is a continuation of the two calf muscles, the gastrocnemius and soleus muscles, and it attaches to the heel bone. It is the strongest tendon in the human body and must withstand great forces. Its function is to transmit the force produced by the calf muscles to lift the heel and produce the push off during walking, running and jumping. The Achilles can produce force of up to seven times body weight. This shows just how much force it has to withstand during sporting activities, such as sprinting, jumping and turning. Causes The Achilles tendon usually ruptures as a result of a sudden forceful contraction of the calf muscles. Activities such as jumping, lunging, or sprinting can cause undue stress on the Achilles tendon and cause it to rupture. Often there is a background of Achilles tendinitis. Direct trauma to the area, poor flexibility or weakness of the calf muscles or of the Achilles tendon and increasing age are some of the other factors that are associated with an Achilles tendon rupture. Symptoms Patients with an Achilles tendon rupture frequently present with complaints of a sudden snap in the lower calf associated with acute, severe pain. The patient reports feeling like he or she has been shot, kicked, or cut in the back of the leg, which may result in an inability to ambulate further. A patient with Achilles tendon rupture will be unable to stand on his or her toes on the affected side. Diagnosis The diagnosis of an Achilles tendon rupture can be made easily by an orthopedic surgeon. The defect in the tendon is easy to see and to palpate. No x-ray, MRI or other tests are necessary. Non Surgical Treatment A physical therapist teaches you exercises to help improve movement and strength, and to decrease pain. Use support devices as directed. You may need crutches or a cane for support when you walk. These devices help decrease stress and pressure on your tendon. Your caregiver will tell you how much weight you can put on your leg. Ask for more information about how to use crutches or a cane correctly. Start activity as directed. Your caregiver will tell you when it is okay to walk and play sports. You may not be able to play sports for 6 months or longer. Ask when you can go back to work or school. Do not drive until your caregiver says it is okay. Surgical Treatment In general, for complete tear of the tendon, surgery is recommended. For partial tears, nonsurgical treatment is recommended. However, the selection of treatment depends on the patient, age, level of activity, and other risk factors. Surgery for Achilles tendon rupture is now routine and well established. Surgery is generally suggested for the young, healthy and active individuals. For athletes, surgery is often the first choice of treatment. The Achilles tendon can be repaired surgically by either a closed or open technique. With the open technique, an incision is made to allow for better visualization and approximation of the tendon. With the closed technique, the surgeon makes several small skin incisions through which the tendon is repaired. Irrespective of type of treatment, a short leg cast (plaster) is applied on the operated ankle after completion of the procedure. The advantages of a surgical approach includes a decreased risk of re-rupture rate (0%-5%) the majority of individuals can return to their original sporting activities (within a short time), and most regain their strength and endurance. Disadvantages of a surgical approach include hospital admission, wound complications (for example, skin sloughing, infection, sinus tract formation, sural nerve injury), higher costs, and hospital admission.