Overview
The Achilles tendon is the confluence of the independent tendons of the gastrocnemius and soleus, which fuse to become the Achilles tendon approximately 5 to 6 cm proximal to its insertion on the posterior surface of the calcaneus. The gastrocnemius and soleus muscles, via the Achilles tendon, function as the chief plantarflexors of the ankle joint. This musculotendinous unit provides the primary propulsive force for walking, running, and jumping. The normal Achilles tendon can withstand repetitive loads near its ultimate tensile strength, which approach 6 to 8 times body weight.
Causes
An Achilles tendon rupture is often caused by overstretching the tendon. This typically occurs during intense physical activity, such as running or playing basketball. Pushing off from the foot while the knee is straight, pivoting, jumping, and running are all movements that can overstretch the Achilles tendon and cause it to rupture. A rupture can also occur as the result of trauma that causes an over-stretching of the tendon, such as suddenly tripping or falling from a significant height. The Achilles tendon is particularly susceptible to injury if it is already weak. Therefore, individuals who have a history of tendinitis or tendinosis are more prone to a tendon rupture. Similarly, individuals who have arthritis and overcompensate for their joint pain by putting more stress on the Achilles tendon may also be more susceptible to an Achilles tendon rupture.
Symptoms
A person with a ruptured Achilles tendon may experience one or more of the following. Sudden pain (which feels like a kick or a stab) in the back of the ankle or calf, often subsiding into a dull ache. A popping or snapping sensation. Swelling on the back of the leg between the heel and the calf. Difficulty walking (especially upstairs or uphill) and difficulty rising up on the toes. These symptoms require prompt medical attention to prevent further damage. Until the patient is able to see a doctor, the "R.I.C.E." method should be used. This involves, rest. Stay off the injured foot and ankle, since walking can cause pain or further damage. Ice. Apply a bag of ice covered with a thin towel to reduce swelling and pain. Do not put ice directly against the skin. Compression. Wrap the foot and ankle in an elastic bandage to prevent further swelling. Elevation. Keep the leg elevated to reduce the swelling. It should be even with or slightly above heart level.
Diagnosis
In diagnosing an Achilles tendon rupture, the foot and ankle surgeon will ask questions about how and when the injury occurred and whether the patient has previously injured the tendon or experienced similar symptoms. The surgeon will examine the foot and ankle, feeling for a defect in the tendon that suggests a tear. Range of motion and muscle strength will be evaluated and compared to the uninjured foot and ankle. If the Achilles tendon is ruptured, the patient will have less strength in pushing down (as on a gas pedal) and will have difficulty rising on the toes. The diagnosis of an Achilles tendon rupture is typically straightforward and can be made through this type of examination. In some cases, however, the surgeon may order an MRI or other advanced imaging tests.
Non Surgical Treatment
Non-operative treatment consists of placing the foot in a downward position [equinus] and providing relative immobilization of the foot in this position until the Achilles has healed. This typically involves some type of stable bracing or relative immobilization for 6 weeks, often with limited or no weight bearing. The patient can then be transitioned to a boot with a heel lift and then gradually increase their activity level within the boot. It is very important that the status of the Achilles is monitored throughout non-operative treatment. This can be done by examination or via ultrasound. If there is evidence of gapping or non-healing, surgery may need to be considered. Formal protocols have been developed to help optimize non-operative treatments and excellent results have been reported with these protocols. The focus of these treatments is to ensure that the Achilles rupture is in continuity and is healing in a satisfactory manner. The primary advantage of non-operative treatment is that without an incision in this area, there are no problems with wound healing or infection. Wound infection following Achilles tendon surgery can be a devastating complication and therefore, for many patients, non-operative treatment should be contemplated. The main disadvantage of non-operative treatment is that the recovery is probably slower. On average, the main checkpoints of recovery occur 3-4 weeks quicker with operative treatment than with non-operative treatment. In addition, the re-rupture rate appears to be higher with some non-operative treatments. Re-rupture typically occurs 8-18 months after the original injury.
Surgical Treatment
Thanks to a new surgical technique, operative procedures are often more beneficial.The operative treatment of Achilles tendon ruptures has significantly changed in recent years. The objective today is to connect the torn tendons using modern suture and possibly adhesive materials. Through small surgical incisions the ends of the torn tendon are surgically exposed, and sutures are used to tie the ends permanently together. Thus, the operated repaired tendon is again resilient within a reasonable time. The cast treatment and walking on crutches required in the past, is with this procedure usually not necessary. Instead, functional treatment following the surgery involves wearing a special boot, meaning that the patient can put weight onto the operated leg again within a few days after surgery. Physical therapy training will start immediately following the operation. The philosophy behind such an early functional treatment is that tissue adequately adapts to stress and thus accelerates the healing process. For the patient, the modern surgical treatment of an Achilles tendon rupture has the distinct advantage that no prolonged hospital stay is necessary. Hospital stay usually lasts only a few days. Using crutches, patients can return to work soon after the surgery.
The Achilles tendon is the confluence of the independent tendons of the gastrocnemius and soleus, which fuse to become the Achilles tendon approximately 5 to 6 cm proximal to its insertion on the posterior surface of the calcaneus. The gastrocnemius and soleus muscles, via the Achilles tendon, function as the chief plantarflexors of the ankle joint. This musculotendinous unit provides the primary propulsive force for walking, running, and jumping. The normal Achilles tendon can withstand repetitive loads near its ultimate tensile strength, which approach 6 to 8 times body weight.Causes
An Achilles tendon rupture is often caused by overstretching the tendon. This typically occurs during intense physical activity, such as running or playing basketball. Pushing off from the foot while the knee is straight, pivoting, jumping, and running are all movements that can overstretch the Achilles tendon and cause it to rupture. A rupture can also occur as the result of trauma that causes an over-stretching of the tendon, such as suddenly tripping or falling from a significant height. The Achilles tendon is particularly susceptible to injury if it is already weak. Therefore, individuals who have a history of tendinitis or tendinosis are more prone to a tendon rupture. Similarly, individuals who have arthritis and overcompensate for their joint pain by putting more stress on the Achilles tendon may also be more susceptible to an Achilles tendon rupture.
Symptoms
A person with a ruptured Achilles tendon may experience one or more of the following. Sudden pain (which feels like a kick or a stab) in the back of the ankle or calf, often subsiding into a dull ache. A popping or snapping sensation. Swelling on the back of the leg between the heel and the calf. Difficulty walking (especially upstairs or uphill) and difficulty rising up on the toes. These symptoms require prompt medical attention to prevent further damage. Until the patient is able to see a doctor, the "R.I.C.E." method should be used. This involves, rest. Stay off the injured foot and ankle, since walking can cause pain or further damage. Ice. Apply a bag of ice covered with a thin towel to reduce swelling and pain. Do not put ice directly against the skin. Compression. Wrap the foot and ankle in an elastic bandage to prevent further swelling. Elevation. Keep the leg elevated to reduce the swelling. It should be even with or slightly above heart level.
Diagnosis
In diagnosing an Achilles tendon rupture, the foot and ankle surgeon will ask questions about how and when the injury occurred and whether the patient has previously injured the tendon or experienced similar symptoms. The surgeon will examine the foot and ankle, feeling for a defect in the tendon that suggests a tear. Range of motion and muscle strength will be evaluated and compared to the uninjured foot and ankle. If the Achilles tendon is ruptured, the patient will have less strength in pushing down (as on a gas pedal) and will have difficulty rising on the toes. The diagnosis of an Achilles tendon rupture is typically straightforward and can be made through this type of examination. In some cases, however, the surgeon may order an MRI or other advanced imaging tests.
Non Surgical Treatment
Non-operative treatment consists of placing the foot in a downward position [equinus] and providing relative immobilization of the foot in this position until the Achilles has healed. This typically involves some type of stable bracing or relative immobilization for 6 weeks, often with limited or no weight bearing. The patient can then be transitioned to a boot with a heel lift and then gradually increase their activity level within the boot. It is very important that the status of the Achilles is monitored throughout non-operative treatment. This can be done by examination or via ultrasound. If there is evidence of gapping or non-healing, surgery may need to be considered. Formal protocols have been developed to help optimize non-operative treatments and excellent results have been reported with these protocols. The focus of these treatments is to ensure that the Achilles rupture is in continuity and is healing in a satisfactory manner. The primary advantage of non-operative treatment is that without an incision in this area, there are no problems with wound healing or infection. Wound infection following Achilles tendon surgery can be a devastating complication and therefore, for many patients, non-operative treatment should be contemplated. The main disadvantage of non-operative treatment is that the recovery is probably slower. On average, the main checkpoints of recovery occur 3-4 weeks quicker with operative treatment than with non-operative treatment. In addition, the re-rupture rate appears to be higher with some non-operative treatments. Re-rupture typically occurs 8-18 months after the original injury.
Surgical Treatment
Thanks to a new surgical technique, operative procedures are often more beneficial.The operative treatment of Achilles tendon ruptures has significantly changed in recent years. The objective today is to connect the torn tendons using modern suture and possibly adhesive materials. Through small surgical incisions the ends of the torn tendon are surgically exposed, and sutures are used to tie the ends permanently together. Thus, the operated repaired tendon is again resilient within a reasonable time. The cast treatment and walking on crutches required in the past, is with this procedure usually not necessary. Instead, functional treatment following the surgery involves wearing a special boot, meaning that the patient can put weight onto the operated leg again within a few days after surgery. Physical therapy training will start immediately following the operation. The philosophy behind such an early functional treatment is that tissue adequately adapts to stress and thus accelerates the healing process. For the patient, the modern surgical treatment of an Achilles tendon rupture has the distinct advantage that no prolonged hospital stay is necessary. Hospital stay usually lasts only a few days. Using crutches, patients can return to work soon after the surgery.
