Overview
The Achilles tendon is the thickest and strongest tendon in the human body. It plays a very important role in most sport activities and is particularly vulnerable to overloading from repetitive running and jumping. The Achilles tendon forms a joint distal tendon for the gastrocnemius and the soleus muscles. These muscles combine to form the triceps surae muscle. Athletes who sustain Achilles tendon ruptures most frequently are those who participate in ball sports that demand rapid changes of direction and quick, reactive jumps (e.g., tennis, squash, badminton, and soccer), in addition to runners and jumpers in track and field. Sometimes a patient with a ruptured tendon has a history of long-term pain localized to the tendon, but more often the rupture occurs without warning. Such ruptures are often caused by degenerative changes in the tendon (tendinosis), usually in the segment of the tendon that has the worst blood supply. This segment extends from 2 to 6 cm proximal to the insertion of the tendon onto the calcaneus.
Causes
Repeated stress from a variety of causes is often the cause of Achilles tendon injury. The stress may occur from any of the following. Excessive activity or overuse. Flat feet. Poorly fitting or inadequate shoes. Inadequate warm-up or proper conditioning. Jogging or running on hard surfaces. Older recreational athlete. Previous Achilles tendon injury (tendonitis/rupture). Repeated steroid injections. Sudden changes in intensity of exercise. Use of fluoroquinolone antibiotics (especially in children). Trauma to the ankle. Tense calf muscles prior to exercise. Weak calf muscles.
Symptoms
If you rupture your Achilles tendon, you may hear a snapping or popping sound when it happens. You will feel a sudden and sharp pain in your heel or calf (lower leg). It might feel like you have been kicked or hit in the back of your leg. You may also have swelling in your calf. be unable to put your full weight on your ankle, be unable to stand on tiptoe, or climb stairs, have bruising around the area. If you have any of these symptoms and believe you have ruptured your Achilles tendon, go straight to accident and emergency at your local hospital. If you partially rupture your Achilles tendon, the tear may only be small. Symptoms of pain and stiffness may come on quite suddenly like a complete rupture, but may settle over a few days.
Diagnosis
A typical history as detailed above together with positive clinical examination usually will clinch the diagnosis. In an acute rupture, one can usually feel the gap in the tendon from the rupture. There may be swelling or bruising around the ankle and foot of the injured leg. With the patient lying on the tummy (prone position) with the knee flexed, the examiner should see the ankle and foot flex downwards (plantarward) when squeezing the calf muscles. If there is no movement in the ankle and foot on squeezing the calf muscle, this implies that the calf muscle is no longer attached to the heel bone due to a complete Achilles tendon rupture.
Non Surgical Treatment
Nonsurgical treatment involves extended casting, special braces, orthotics, and physical therapy. Avoids the normal complications and expenses of surgery. Some studies show the outcome is similar to surgery in regard to strength and function. There is risk of an over-lengthened tendon with inadequate tension. Extended immobilization can lead to more muscle weakness. Nonsurgical treatment has a higher incidence of re-rupture than surgical repair. Nonsurgical treatment is often used for nonathletes or for those with a general low level of physical activity who would not benefit from surgery. The elderly and those with complicating medical conditions should also consider conservative nonsurgical treatment.
Surgical Treatment
Operative treatment of Achilles tendon ruptures involves opening the skin and identifying the torn tendon. This is then sutured together to create a stable construct. This can be performed through a standard Achilles tendon repair technique or through a mini-incision technique (to read about the different types of techniques, look under ?Procedure? in Achilles Tendon Repair). By suturing the torn tendon ends together, they maintain continuity and can be mobilized more quickly. However, it is critical to understand that the return to normal activities must wait until adequate healing of the tendon has occurred. The potential advantages of an open repair of the Achilles tendon include, faster recovery, this means that patients will lose less strength. Early Range of Motion. They are able to move the ankle earlier so it is easier to regain motion. Lower Re-rupture Rate. The re-rupture rate may be significantly lower in operatively treated patients (2-5%) compared to patients treated non-operatively (8-15%). The main disadvantage of an open repair of the Achilles tendon rupture is the potential for a wound-healing problem which could lead to a deep infection that is difficult to eradicate, or a painful scar.
Prevention
The following can significantly reduce the risk of Achilles tendon rupture. Adequate stretching and warming up prior to exercising. If playing a seasonal sport, undertake preparatory exercises to build strength and endurance before the sporting season commences. Maintain a healthy body weight. This will reduce the load on the tendon and muscles. Use footwear appropriate for the sport or exercise being undertaken. Exercise within fitness limits and follow a sensible exercise programme. Increase exercise gradually and avoid unfamiliar strenuous exercise. Gradual ?warm down? after exercising.
The Achilles tendon is the thickest and strongest tendon in the human body. It plays a very important role in most sport activities and is particularly vulnerable to overloading from repetitive running and jumping. The Achilles tendon forms a joint distal tendon for the gastrocnemius and the soleus muscles. These muscles combine to form the triceps surae muscle. Athletes who sustain Achilles tendon ruptures most frequently are those who participate in ball sports that demand rapid changes of direction and quick, reactive jumps (e.g., tennis, squash, badminton, and soccer), in addition to runners and jumpers in track and field. Sometimes a patient with a ruptured tendon has a history of long-term pain localized to the tendon, but more often the rupture occurs without warning. Such ruptures are often caused by degenerative changes in the tendon (tendinosis), usually in the segment of the tendon that has the worst blood supply. This segment extends from 2 to 6 cm proximal to the insertion of the tendon onto the calcaneus.
Causes
Repeated stress from a variety of causes is often the cause of Achilles tendon injury. The stress may occur from any of the following. Excessive activity or overuse. Flat feet. Poorly fitting or inadequate shoes. Inadequate warm-up or proper conditioning. Jogging or running on hard surfaces. Older recreational athlete. Previous Achilles tendon injury (tendonitis/rupture). Repeated steroid injections. Sudden changes in intensity of exercise. Use of fluoroquinolone antibiotics (especially in children). Trauma to the ankle. Tense calf muscles prior to exercise. Weak calf muscles.
Symptoms
If you rupture your Achilles tendon, you may hear a snapping or popping sound when it happens. You will feel a sudden and sharp pain in your heel or calf (lower leg). It might feel like you have been kicked or hit in the back of your leg. You may also have swelling in your calf. be unable to put your full weight on your ankle, be unable to stand on tiptoe, or climb stairs, have bruising around the area. If you have any of these symptoms and believe you have ruptured your Achilles tendon, go straight to accident and emergency at your local hospital. If you partially rupture your Achilles tendon, the tear may only be small. Symptoms of pain and stiffness may come on quite suddenly like a complete rupture, but may settle over a few days.
Diagnosis
A typical history as detailed above together with positive clinical examination usually will clinch the diagnosis. In an acute rupture, one can usually feel the gap in the tendon from the rupture. There may be swelling or bruising around the ankle and foot of the injured leg. With the patient lying on the tummy (prone position) with the knee flexed, the examiner should see the ankle and foot flex downwards (plantarward) when squeezing the calf muscles. If there is no movement in the ankle and foot on squeezing the calf muscle, this implies that the calf muscle is no longer attached to the heel bone due to a complete Achilles tendon rupture.
Non Surgical Treatment
Nonsurgical treatment involves extended casting, special braces, orthotics, and physical therapy. Avoids the normal complications and expenses of surgery. Some studies show the outcome is similar to surgery in regard to strength and function. There is risk of an over-lengthened tendon with inadequate tension. Extended immobilization can lead to more muscle weakness. Nonsurgical treatment has a higher incidence of re-rupture than surgical repair. Nonsurgical treatment is often used for nonathletes or for those with a general low level of physical activity who would not benefit from surgery. The elderly and those with complicating medical conditions should also consider conservative nonsurgical treatment.
Surgical Treatment
Operative treatment of Achilles tendon ruptures involves opening the skin and identifying the torn tendon. This is then sutured together to create a stable construct. This can be performed through a standard Achilles tendon repair technique or through a mini-incision technique (to read about the different types of techniques, look under ?Procedure? in Achilles Tendon Repair). By suturing the torn tendon ends together, they maintain continuity and can be mobilized more quickly. However, it is critical to understand that the return to normal activities must wait until adequate healing of the tendon has occurred. The potential advantages of an open repair of the Achilles tendon include, faster recovery, this means that patients will lose less strength. Early Range of Motion. They are able to move the ankle earlier so it is easier to regain motion. Lower Re-rupture Rate. The re-rupture rate may be significantly lower in operatively treated patients (2-5%) compared to patients treated non-operatively (8-15%). The main disadvantage of an open repair of the Achilles tendon rupture is the potential for a wound-healing problem which could lead to a deep infection that is difficult to eradicate, or a painful scar.
Prevention
The following can significantly reduce the risk of Achilles tendon rupture. Adequate stretching and warming up prior to exercising. If playing a seasonal sport, undertake preparatory exercises to build strength and endurance before the sporting season commences. Maintain a healthy body weight. This will reduce the load on the tendon and muscles. Use footwear appropriate for the sport or exercise being undertaken. Exercise within fitness limits and follow a sensible exercise programme. Increase exercise gradually and avoid unfamiliar strenuous exercise. Gradual ?warm down? after exercising.