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 tendon is susceptible to injury and can rupture during vigorous activities such as running and jumping. Rupture can also occur as a result of gradual wear. After becoming chronically weakened, it can rupture during non-stress activities like walking. Symptoms Often the person feels a whip-like blow that is followed by weakness in the affected leg - usually he or she is not able to walk afterwards. At place where the tendon ruptured, a significant dent is palpable. Often the experienced physician can diagnose a ruptured Achilles tendon by way of clinical examination and special function tests. Imaging techniques, such as ultrasound and magnetic resonance imaging (MRI) allow for a more precise diagnosis. Diagnosis Laboratory studies usually are not necessary in evaluating and diagnosing an Achilles tendon rupture or injury, although evaluation may help to rule out some of the other possibilities in the differential diagnosis. Plain radiography. Radiographs are more useful for ruling out other injuries than for ruling in Achilles tendon ruptures. Ultrasonography of the leg and thigh can help to evaluate the possibility of deep venous thrombosis and also can be used to rule out a Baker cyst, in experienced hands, ultrasonography can identify a ruptured Achilles tendon or the signs of tendinosis. Magnetic resonance imaging (MRI). MRI can facilitate definitive diagnosis of a disrupted tendon and can be used to distinguish between paratenonitis, tendinosis, and bursitis. Non Surgical Treatment Nonsurgical method is generally undertaken in individuals who are old, inactive, and at high-risk for surgery. Other individuals who should not undergo surgery are those who have a wound infection/ulcer around the heel area. A large group of patients who may not be candidates for surgery include those with diabetes, those with poor blood supply to the foot, patients with nerve problems in the foot, and those who may not comply with rehabilitation. Nonsurgical management involves application of a short leg cast to the affected leg, with the ankle in a slightly flexed position. Maintaining the ankle in this position helps appose the tendons and improves healing. The leg is placed in a cast for six to 10 weeks and no movement of the ankle is allowed. Walking is allowed on the cast after a period of four to six weeks. When the cast is removed, a small heel lift is inserted in the shoe to permit better support for the ankle for an additional two to four weeks. Following this, physical therapy is recommended. The advantages of a nonsurgical approach are no risk of a wound infection or breakdown of skin and no risk of nerve injury. The disadvantages of the nonsurgical approach includes a slightly higher risk of Achilles tendon rupture and the surgery is much more complex if indeed a repair is necessary in future. In addition, the recuperative period after the nonsurgical approach is more prolonged. Surgical Treatment In general, Achilles tendon repair surgery has a much higher success rate and lower incidences of re-rupture than non-surgical methods of treatment. It is preferred by the nation?s leading athletes as the best course of action, allowing them to return to previous activity and performance levels at a much faster rate, with a lower chance or re-injury and less potential muscle loss. Prevention There are things you can do to help prevent an Achilles tendon injury. You should try the following. Cut down on uphill running. Wear shoes with good support that fit well. Always increase the intensity of your physical activity slowly. Stop exercising if you feel pain or tightness in the back of your calf or heel.