What Are Primary Causes And Signs Or Symptoms Of An Achilles Tendon Rupture

Overview

Achilles Tendonitis

The Achilles tendon is the largest tendon in the human body. It connects the calf muscle to the heel bone. However, this tendon is also the most common site of rupture or tendonitis, an inflammation of the tendon due to overuse. Achilles tendon rupture is a partial or complete tear of the Achilles tendon. It comes on suddenly, sometimes with a popping sound, and can be debilitating. A full rupture is more severe, but less common, than a partial rupture. A full rupture splits the Achilles tendon so that it no longer connects the calf muscle to the heel: the calf muscle can no longer cause the foot to ?push off?, so normal walking is impossible. If it is a full rupture, then lightly pinching the Achilles tendon with the forefinger and thumb will reveal a gap in the Achilles tendon. Partial and full Achilles tendon ruptures are most likely to occur in sports requiring sudden stretching, such as sprinting and racquet sports. Partial Achilles tendon tears are also common among middle and long distance runners.




Causes

The cause of Achilles tendon ruptures besides obviously direct trauma, is multifactorial. In many instances the rupture occurs about 2-6 cm before its attachment to the calcaneous (heel bone). In this area there is a weaker blood supply making it more susceptible to injury and rupture. Rigid soled shoes can also be the causative factor in combination with the structure of your foot being susceptible to injury.




Symptoms

Symptoms of an Achilles tendon rupture usually directly follow a traumatic event where the foot is forced in an upward position at the ankle, causing a sudden tight stretch of the Achilles tendon. There can also be a direct blow to the tendon causing a rupture. There is typically a popping feeling or even a popping sound described during the occurance of the rupture. Typically there is pain with swelling in the region. Often the patient is unable to put weight on this foot as there is too much pain.




Diagnosis

The diagnosis is usually made on the basis of symptoms, the history of the injury and a doctor's examination. The doctor may look at your walking and observe whether you can stand on tiptoe. She/he may test the tendon using a method called Thompson's test (also known as the calf squeeze test). In this test, you will be asked to lie face down on the examination bench and to bend your knee. The doctor will gently squeeze the calf muscles at the back of your leg, and observe how the ankle moves. If the Achilles tendon is OK, the calf squeeze will make the foot point briefly away from the leg (a movement called plantar flexion). This is quite an accurate test for Achilles tendon rupture. If the diagnosis is uncertain, an ultrasound or MRI scan may help. An Achilles tendon rupture is sometimes difficult to diagnose and can be missed on first assessment. It is important for both doctors and patients to be aware of this and to look carefully for an Achilles tendon rupture if it is suspected.




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.

Achilles Tendonitis




Surgical Treatment

Surgical techniques for rupture repair are varied but usually involve reapproximation of the torn ends of the Achilles tendon, sometimes reinforced by the gastrocsoleus aponeurosis or plantaris tendon. Open reconstruction is undertaken using a medial longitudinal approach. Studies indicate that patients who undergo percutaneous, rather than an open, Achilles tendon rupture repair have a minimal rate of infection but a high rate of sural nerve entrapment (16.7% of treated cases).




Prevention

Prevention centers on appropriate daily Achilles stretching and pre-activity warm-up. Maintain a continuous level of activity in your sport or work up gradually to full participation if you have been out of the sport for a period of time. Good overall muscle conditioning helps maintain a healthy tendon.

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