The Achilles tendon (tendo calcaneus) unites the three bulging calf muscles (triceps surae) in a tendon, and connects the muscles to the heel bone.
The Achilles tendon is the strongest tendon in the human body as it transmits the force of the calf muscles of the heel, thus enabling the rolling movement when walking. Especially executing a tiptoe, this is not possible without the proper functioning of this tendon
An Achilles tendon rupture is a sudden partial or complete transection of the Achilles tendon. Since the connection between the calf and heel is fully or partially severed, the person will have difficulty using that leg for some time.
Even after an Achilles tendon rupture, the affected ankle will still have very limited functionality. Usually it may not even be possible to put strain on the foot or tiptoe again. Due to the strength of the tendon, a healthy tendon will almost never rupture. Most often, the tendon tissue is already damaged: by a persistent irritation or inflammation by micro-trauma (small cracks), which have reduced the resilience of the tendon tissue.
The most common cause of an Achilles tendon rupture is acute trauma. It is not usually an external force but a sudden, heavy load in previously damaged tendon – for example, by movements that involve the ankle directly, such that can occur in the approach to a sprint, a sudden jumping movement as seen in sports such as volleyball, basketball or gymnastics and during fast changes of direction in squash. The other main causes of Achilles tendon rupture can be put down to:
- Lack of physical condition,
- Old age
- Headed local glucocorticoid injections
- Taking fluoroquinolones (gyrase inhibitors)
- Tyepe 2 diabetes
- Familial hypercholesterolemia
When a prior minor injury has occurred to the area, overuse of the tendon during exercise can aggravate the micro-injuries, that coupled with insufficient rest can further weaken the tendon. The tendon can also rupture due to age-related degenerative changes and thus is more likely to be susceptible to weakness. Only very rarely is external brute force reason for an Achilles tendon rupture.
An Achilles tendon injury is usually accompanied by a clearly audible, whip-like noise.
- The injured person often feels immediately when the tendon is torn due to a painful sting or shock in the area of the calf or heel. In football, the injured person may think an opponent has kicked him in the heel.
- Usually, as a result of the tendon rupture, the toe cannot be bent downwards although standing or walking are indeed still occasionally possible but in pain.
- Rotation of the ankle or toes is now also no longer possible.
The diagnosis for an Achilles tendon rupture is usually carried out though clinical inspection and palpation of the area. There are three different examinations that are carried out to determine the severity of the injury, these include:
A clinical professional will use their finders to feel for a palpable dent at the tendon transection. Additionally when prompted, the patient will not be able to stand on their tip toe.
Positive Thompson test:
The Thompson-test checks the movement and operability of the Achilles tendon. For this process, the patient is laid in the prone position on the examination table, with his or her feet protruding beyond the edge of the couch.
The examiner then compresses the calf muscles, if the Achilles tendon is intact then the plantar foot can be extended downward (plantar flexion ). The test would thus “Thompson-negative”, if the calf compression causes no motion in the foot then there is an Achilles tendon rupture/injury.
An ultrasound (sonography) can help to determine the exact location of the tear and the spacing of the two free ends of each tendon
Magnetic Resonance Imaging (MRI):
This is usually carried out if an ultrasound does not provide a full overview of the injury, or if there are unexplained findings in the initial x-ray. An MRI scan can help to accurately assess the quality of the tendon and is useful for accurate operational planning also.
How is it treated?
This is usually common in elderly patients and those with comorbidities. Here, the calf is fixed with a splint, special shoe or cast for 4-6 weeks. These methods are also useful for those suffering from equinus (tight calf muscles/achilles tendon) which often increases the risk of Achilles tendon rupture.
These conservative treatment methods, help in bringing the foot gradually into the normal position as the tendons heal together.
- The special orthopaedic shoe or cast should be worn day and night for the first three weeks
- After about four weeks, the sales increase will be reduced by 1 cm and after six weeks by a further 1 cm.
- The shoe/cast is usually worn six to eight weeks.
- Return to sporting activity is usually between 13-16 weeks.
Surgical treatment is usually preferential for younger and physically active patients providing a lower risk (2-3%) of re-rupture as compared to 2-8% for conservative therapy.
The procedure can be performed under local or general anaesthesia can be performed. In a fresh Achilles tendon rupture, the direct end-to-end tendon suture is the method of choice. In older cases the tendon stumps usually have been retracted and plastic methods for bridging the defect is necessary. Surgical techniques commonly used are the overturning, the Z-plasty, the stylus bay – and the peroneus brevis plastic
There are several ways in which to reduce the chance of an achilles tendon rupture. Although normal wear and tear of the Achilles tendon cannot always be helped or avoided, nevertheless, there are ways to reduce the overall risk of injury:
- Do not overload your ankle/foot
- Take the proper precautionary measures for full recovery of previous foot /ankle injuries
- Regular exercise and participation in sport is helpful
- Always warm up effectively before training
- Only gradually increase during exercise stress
- Wear good fitting shoes, adapted to your sole and feet for reduced stress on the heel and feet.