Achilles Tendon Rupture

achilles-tendon-rupture-inner-imageThe Achilles tendon rupture is not a rare injury. Annually,more than out of every 100,000 people suffer an achilles tendon rupture. Men are affected more than women. Typically, an achilles tendon rupture occurs between the ages of 20 and 50 years.

The Achilles tendon connects the calf muscle “Musculus Triceps Surae” with the heel bone. Musculus Triceps Surae allows us to reduce the tip of the foot down (such as when Pressing the gas pedal in the car or when walking on the tips of your toes). The Achilles tendon has a length of ten to twelve centimeters and is the strongest tendon of the body.


Achilles Tendon Rupture Symptoms

If the achilles tendon is torn,typical symptoms occur. Affected persons report a sudden snap or whip-like pain followed by a violently pain above the heel. Walking becomes more diffucult than usual. A swelling on the back of the ankle and the calf can also indicate an Achilles tendon rupture. Sometimes, a bruise can also be seen above the heel.


Achilles Tendon Rupture Causes and Risk Factors

Achilles tendon rupture is most frequently caused as abrupt or strong tensioning of the tendon. Typical sports are football, sprinting,badminton, basketball, tennis and squash activities which require rapid stop-and-go movements  sprints and also partial jumps. As a rule, affected tendon is already damaged for example by aging processes or by micro-injuries as a result of sportive overuse and a lack of training pauses. The risk factors for an Achilles tendon rupture are as follows:

  • Higher Age
  • Muscle Failure
  • Male Gender
  • Ingestion of (quinolone) antibiotics, anabolic steroids and cortisone
  • In addition, bad footwear, deviations of the foot axis and foot deformities increase achilles tendon rupture.

In over 70 percent of the cases, achilles tendon rupture occurs in the middle region of the tendon since the blood flow is the worst. This also makes healing more difficult.


Achilles Tendon Rupture Diagnosis

The specialists for an achilles tendon tear and other tendon tears are orthopedists and accident surgeons. Most affected persons immediately seek an emergency ambulance for acute symptoms.

First, the attending physician will ask you several questions such as:

  • Can you run normally?
  • Have your symptoms occurred suddenly?
  • How did the accident happen?
  • Have you ever seen anything similar?

Firstly, blood flow, sensitivity and motor activity in the area of the lower leg and the foot must be examined. In addition, the doctor scans the achilles tendon. An important investigation in case of suspected an Achilles tendon rupture is the so-called Thompson test. For this purpose, the patient lies in a prone position on a couch. Patient’s feet hang freely over the edge of the couch. Then, the physician presses the calf muscles of the affected leg into a vigorous position. With an Achilles tendon rupture, this plantar flexion remains – the foot does not move.

Imaging procedures

An ultrasound examination is performed to ensure the diagnosis. This allows the physician to determine the rupture site, determine how far the tendons are apart and whether bruises have formed or not.

In some cases, a magnetic resonance tomography (MRI) is performed, for example in the case of unclear findings, chronic complaints and repeated ruptures. This examination is more accurate than the sonography and therefore allows discrete structural changes to be detected.

An X-ray examination is useful in cases of suspected bony involvement.

Differential diagnoses

Alternative diagnoses are muscle fiber tears or tendon infections. In the case of an abdominal weakness, it must also be taken into account that this may be a so-called S1 syndrome. An S1 syndrome is caused by the irritation of a nerve root of the spinal cord at the spine.


Achilles Tendon Rupture Treatment

Conservative TreatmentAchilles Tendon Rupture

If the two ends of the achilles tendon can be brought together in a foot reduction , conservative treatment can be carried out. To do this, patient is given for two weeks with a lower leg in plaster in the position. After that,patient has to wear for six weeks an orthosis shoe which is a custom-designed as increased in the heel area. This steep position of the foot is gradually reduced.

Operation

An Operation has the advantage that it is less likely to re-Rupture and the tendon is then stronger and more viable than after conservative treatment. However, smaller operation can occur complications.

The Operation can be performed either open or minimally invasive. Normally, the two tendon ends are sewn together. However, if the tendon quality is in the area of the crack is very bad, surgeon must apply to special suture techniques (such as pen box, plastic) or a piece of tendon from another part of the body (such as the soles of the feet) which can be incorporated.

General anesthesia is not absolutely necessary, the surgery can often be done with a regional or even local anesthesia. The patient must be stored for the operation in the prone position with feet hanging. The surgeon must compare during the operation as both feet in order to achieve an optimal result. With all surgical procedures care must be taken on the near termination of sural nerve, so this is not violated. This nerve runs around 10 to 15 inches from the heel bone on the lower leg on the outer side of the Achilles tendon.


Achilles Tendon Rupture Prognosis

Prognosis in case of an achilles tendon rupture is very good with professional care. In rare cases, infections, circulatory disorders and / or a shortening or lengthening of the tendon occur. According to both conservative as well as operative therapy for several months after treatment is necessary.

Three to four months after the Achilles tendon rupture, normal sports activities are possible again. Professional athletes should pass away about half a year before they begin the competition training again.

Some patients suffer from chronic pain after an Achilles tendon rupture.

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