The Achilles tendon is formed by two muscles at the back of the calf, the gastrocnemius and the subtalar tendon, about 15 cm above the ankle joint and ending at the back of the heel. The tendon is surrounded by a sheath in which it slides easily during the movement of the ankle. The function of the Achilles tendon is critical for walking and running. When the gastrocnemius contracts, the end leg moves downward. Running and climbing stairs exerts a force through the Achilles tendon equal to 10 times the body weight.
Who can rupture the Achilles tendon?
Approximately 1 million athletes a year suffer an Achilles tendon inflammation or rupture. Achilles tendon rupture is not uncommon in healthy, active individuals. The rupture is usually spontaneous and is most commonly seen in people aged 24 to 45 years. It tends to occur mostly in male athletes. The majority of sufferers have no previous history of pain or previous injury to the tendon. In the majority of cases, the Achilles tendon rupture occurs 2 – 6 cm above the tendon insertion in the heel bone.
Risk factors for Achilles tendon rupture include:
taking corticosteroid medications (either taken orally or injected near the tendon)
taking antibiotics of the fluoroquinolone class (ciprofloxacin, levofloxacin)
previous injury to the Achilles tendon (increases the risk of rupture of the tendon, both on the side that was originally injured and on the other side that was not affected).
Usually, the Achilles tendon is ruptured when there is a sudden, strong downward movement of the leg against resistance, such as when someone pushes the leg with great force when jumping. This often happens in sports such as basketball, tennis or football.
Symptoms of a tear include:
acute sudden pain in the back of the heel
weakness of plantar flexion of the foot
Because there is an imbalance between the muscles that push the toes down and those that pull them up, walking becomes difficult with the pain and because the foot will drag. Sometimes the tendon does not completely rupture, but only partially ruptures. The symptoms are the same as a full tear and a partial tear can develop into a full tear. While a rupture of the Achilles tendon usually occurs near its insertion in the heel, it can occur at any position along the course of the tendon.
How is a rupture of the Achilles tendon diagnosed?
The diagnosis is made through clinical examination by an Orthopaedic Surgeon. The physician may submit the patient to the Thompson test. Certainly the diagnosis is confirmed by ultrasound and MRI.
Achilles Tendon Rupture – Treatment
There are two options for the treatment of Achilles tendon rupture. One involves surgical repair and the other involves conservative treatment (allowing the tendon to heal itself using a cast). Each method has its benefits and risks and decisions will depend on:
the clinical condition of the patient
the underlying medical history
the extent of the injury
the extent of the injury, the extent of the injury, the extent of the injury, the extent of the injury, the extent of the injury, the extent of the injury, the extent of the injury, the extent of the injury and the expectation of future activity
Surgery is the recommended treatment for young, healthy and active individuals. For athletes, surgery is often the first treatment option. The Achilles tendon can be surgically repaired either percutaneously or with an open technique. Advantages of the surgical approach include a reduced risk of re-rupture (0% -5%). The majority of patients can return to their original sporting activities (in a short period of time) and regain strength and endurance. Disadvantages of the surgical approach include cost, the need for hospitalization and complications of trauma.
Conservative treatment may be recommended for patients who are older, less active and with comorbidities. The ability to heal the surgical wound is also a major concern and may include patients with inadequate blood supply to the lower extremities. Conservative management includes application of a shin splint in a hippopotamus. Keeping the foot in this position helps the wounds to heal. The splint remains in place for 6 to 10 weeks and no movement of the ankle is allowed. After removal of the cast, physical therapy is recommended. Disadvantages of the conservative approach include an increased risk of re-rupture (up to 40%) and prolonged immobilisation. Benefits include reduced risk of infection and skin damage and reduced risk of neurovascular damage.
For a personalized diagnosis contact Dr. Antonis Petta. The doctor has specialized in foot and ankle surgeries. He has extensive experience and will responsibly guide you as to the treatment of your problem.