Overview
The Achilles tendon is a conjoined tendon composed of the gastrocnemius and soleus muscles with occasional contribution from the plantaris muscle, and it inserts on the calcaneal tuberosity. The plantaris muscle is absent in 6% to 8% of individuals. The Achilles tendon is approximately 15-cm long and is the largest and strongest tendon in the human body. The tendon spirals approximately 90 from its origin to its insertion and this twisting produces an area of stress approximately 2- to 5-cm proximal to its insertion. The tendon has no true synovial sheath; instead it is wrapped in a paratenon. The Achilles tendon experiences the highest loads of any tendon in the body, and bears tensile loads up to 10 times body weight during athletic activities. The tendon most commonly ruptures in a region 2- to 6-cm proximal to its insertion.
Causes
Causes of and contributors to Achilles tendon rupture include trauma (caused by injury, usually an acceleration injury such as pushing off or jumping up). Preceding tendon problems. Chronic Achilles tendonitis (can lead to small tears within the tendon, increasingly weakening it). Certain drug therapies/treatments. Drugs that have been linked to Achilles tendon rupture include. Fluoroquinolone antibiotics - after nearly 900 reports of tendon ruptures, tendonitis and other tendon disorders (most associated with the Achilles tendon) linked to Ciprofloxacin (Cipro) alone were collected in the U.S. Food and Drug Administration (FDA)s database, at least one public-interest group petitioned the FDA to recommend that a "Black Box Warning" be added to Cipro's packaging. Some researchers speculate this class of antibiotics is toxic to tendon fibers, and that in some cases may reduce their blood supply. Patients should at least be more aware of the potential for ruptures so that they can be switched to other antibiotics at the onset of early warning signals such as tendon pain.
Symptoms
Patients who suffer an acute rupture of the Achilles tendon often report hearing a popor snap. Patients usually have severe pain the back of the lower leg near the heel. This may or may not be accompanied by swelling. Additionally, because the function of the Achilles tendon is to enable plantarflexion (bending the foot downward), patients often have difficulty walking or standing up on their toes. With a complete rupture of the tendon, the foot will not move. In cases where the diagnosis is equivocal, your physician may order an MRI of the leg to diagnose a rupture of the Achilles tendon.
Diagnosis
An Achilles' tendon injury can be diagnosed by applying the Thompson Test (or Calf Squeeze Test) this is where the person who has suffered the injury lies on their front with their legs bent. Whoever is performing the test, usually a doctor, will then squeeze the calf muscle. If the tendon has not ruptured then the foot should point briefly away from the leg.
Non Surgical Treatment
Non-surgical treatment of Achilles tendon rupture is usually reserved for patients who are relatively sedentary or may be at higher risk for complications with surgical intervention (due to other associated medical problems). This involves a period of immobilization, followed by range of motion and strengthening exercises; unfortunately, it is associated with a higher risk of re-rupture of the tendon, and possibly a less optimal functional outcome.
Surgical Treatment
The goal of surgery is to realign the two ends of the ruptured tendon to allow healing. There are multiple techniques to accomplish this goal that will vary from surgeon to surgeon. Recovery from this injury is usually very successful with return to full function in approximately 6 months. Post operatively casting is required with the use of crutches or other means to remain non-weightbearing for 4-8 weeks. This is followed by a course of physical therapy. Partial rupture may or may not require surgical intervention depending on the extent of injury but cast immobilization is a common requirement.
Prevention
You can help to reduce your risk of an injury to your Achilles tendon by doing the following. When you start a new exercise regime, gradually increase the intensity and the length of time you spend being active. Warm up your muscles before you exercise and cool them down after you have finished. The benefit of stretching before or after exercise is unproven. However, it may help to stretch your calf muscles, which will help to lengthen your Achilles tendon, before you exercise. Wear appropriate and well-fitting shoes when you exercise.
The Achilles tendon is a conjoined tendon composed of the gastrocnemius and soleus muscles with occasional contribution from the plantaris muscle, and it inserts on the calcaneal tuberosity. The plantaris muscle is absent in 6% to 8% of individuals. The Achilles tendon is approximately 15-cm long and is the largest and strongest tendon in the human body. The tendon spirals approximately 90 from its origin to its insertion and this twisting produces an area of stress approximately 2- to 5-cm proximal to its insertion. The tendon has no true synovial sheath; instead it is wrapped in a paratenon. The Achilles tendon experiences the highest loads of any tendon in the body, and bears tensile loads up to 10 times body weight during athletic activities. The tendon most commonly ruptures in a region 2- to 6-cm proximal to its insertion.
Causes
Causes of and contributors to Achilles tendon rupture include trauma (caused by injury, usually an acceleration injury such as pushing off or jumping up). Preceding tendon problems. Chronic Achilles tendonitis (can lead to small tears within the tendon, increasingly weakening it). Certain drug therapies/treatments. Drugs that have been linked to Achilles tendon rupture include. Fluoroquinolone antibiotics - after nearly 900 reports of tendon ruptures, tendonitis and other tendon disorders (most associated with the Achilles tendon) linked to Ciprofloxacin (Cipro) alone were collected in the U.S. Food and Drug Administration (FDA)s database, at least one public-interest group petitioned the FDA to recommend that a "Black Box Warning" be added to Cipro's packaging. Some researchers speculate this class of antibiotics is toxic to tendon fibers, and that in some cases may reduce their blood supply. Patients should at least be more aware of the potential for ruptures so that they can be switched to other antibiotics at the onset of early warning signals such as tendon pain.
Symptoms
Patients who suffer an acute rupture of the Achilles tendon often report hearing a popor snap. Patients usually have severe pain the back of the lower leg near the heel. This may or may not be accompanied by swelling. Additionally, because the function of the Achilles tendon is to enable plantarflexion (bending the foot downward), patients often have difficulty walking or standing up on their toes. With a complete rupture of the tendon, the foot will not move. In cases where the diagnosis is equivocal, your physician may order an MRI of the leg to diagnose a rupture of the Achilles tendon.
Diagnosis
An Achilles' tendon injury can be diagnosed by applying the Thompson Test (or Calf Squeeze Test) this is where the person who has suffered the injury lies on their front with their legs bent. Whoever is performing the test, usually a doctor, will then squeeze the calf muscle. If the tendon has not ruptured then the foot should point briefly away from the leg.
Non Surgical Treatment
Non-surgical treatment of Achilles tendon rupture is usually reserved for patients who are relatively sedentary or may be at higher risk for complications with surgical intervention (due to other associated medical problems). This involves a period of immobilization, followed by range of motion and strengthening exercises; unfortunately, it is associated with a higher risk of re-rupture of the tendon, and possibly a less optimal functional outcome.
Surgical Treatment
The goal of surgery is to realign the two ends of the ruptured tendon to allow healing. There are multiple techniques to accomplish this goal that will vary from surgeon to surgeon. Recovery from this injury is usually very successful with return to full function in approximately 6 months. Post operatively casting is required with the use of crutches or other means to remain non-weightbearing for 4-8 weeks. This is followed by a course of physical therapy. Partial rupture may or may not require surgical intervention depending on the extent of injury but cast immobilization is a common requirement.
Prevention
You can help to reduce your risk of an injury to your Achilles tendon by doing the following. When you start a new exercise regime, gradually increase the intensity and the length of time you spend being active. Warm up your muscles before you exercise and cool them down after you have finished. The benefit of stretching before or after exercise is unproven. However, it may help to stretch your calf muscles, which will help to lengthen your Achilles tendon, before you exercise. Wear appropriate and well-fitting shoes when you exercise.