Achilles Tendon Rupture

Where does the Achilles tendon get its name?

The Achilles tendon gets its name from the Greek warrior Achilles. He was made invincible when he was dipped into the river Styx by his mother Thetis, except for the heel area that he was held by. During the siege of Troy, he was mortally wounded when he was struck in the heel with an arrow shot by the Trojan prince Paris.

Achilles

Achilles

What is the Achilles tendon?

The Achilles tendon is the largest and strongest tendons in the body made up of the tendons for the gastrocnemius and soleus muscles at the back of the leg, inserting into the back of the heel bone (calcaneus).
During almost all activities, from standing, walking, running, and jumping, the muscle and tendon complex contracts and lengthens under load. The role of the tendon is to plantarflex, or “plant” the foot. The outer casing of the tendon, the paratenon, is different than other tendons in that it doesn’t have a synovial sheath. Within the tendon, from 2cm to 6cm from the insertion in the heel bone, there is a zone that is less vascularized, meaning it receives less than optimal blood flow, and is therefore more susceptible to problems.

Calf and Tendon Muscles

Calf and Tendon Muscles

Who ruptures this tendon?

Starting from the 2nd to the 8th decade, ruptures can happen to practically anyone. Most often, those that rupture their Achilles tendon do so in their twenties to forties. Most people report that it feels like someone kicks them in the back of the leg and a loud, audible pop, but direct trauma, (direct blow, crush injury, lacerations) is uncommon.

Why does it rupture?

The tendon is usually weakened by degeneration and mechanical stress. A forceful, unexpected dorsiflexion in conjunction with a strong contraction of the Achilles tendon has been described as how this occurs. Tripping on a curb, or unexpectedly stepping into a hole, jumping from a height.

Ruptured Tendon

Ruptured Tendon

Diagnosing Achilles Tendon Rupture
-A gap that you can feel
-Decreased strength in planting the foot
-Bruising and swelling over the tendon within 24 hours
-Positive Thompson test – squeezing the calf just below the thickest point of the lower leg muscle. Normally, this will cause the foot to flex, but in the patient with an Achilles tendon rupture, there is no movement.
-Xrays, ultrasound, and MRI call confirm the clinical diagnosis

What are the treatment options?

Conservative:
Preventing movement of the area through cast immobilization with the toes slightly pointed down. There is a slightly higher rate of rerupture with this method; the tendon may heal longer than the original length.

Surgical:
For the young athlete, primary repair of the rupture seems to be the treatment of choice. The Achilles tendon can be repaired with small incisions or with one large incision, depending on the surgeon’s choice. One study concluded that the open technique and early range of motion and mobilization gives the best recovery.

References:

Mann’s Surgery of the Foot and Ankle 9th edition. Philadelphia, PA. 2014

Images:

www.wordfocus.com – The story about Achilles heel
www.qs-health.com – Achilles Tendonitis
www.bioniccrossfit.com – Achilles Tendonitis/Rupture

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