Overview
The Achilles tendon is the soft tissue located in the heel which connects calf muscle to the heel bone allowing the body to perform certain activities such as rising on the tip toes and pushing off when running or walking. Achilles tendon tears occur when the tendon becomes torn through excessive pressure put on the area which the tendon is unable to withstand. Tears are most commonly found when suddenly accelerating from a standing position and therefore is often seen in runners and athletes involved in racquet sports. A tear can also occur when a continuous force is being put on the heel through prolonged levels of activity and overuse however this can also occur as a result of sudden impact or force to the area common in contact sports such as rugby and hockey. Although Achilles tendon tears can range in their severity, a rupture is the most serious form of tear and involves a completely torn tendon. This injury is more common in patients in their 30?s and 40?s.
Causes
An Achilles tendon injury might be caused by several factors. Overuse. Stepping up your level of physical activity too quickly. Wearing high heels, which increases the stress on the tendon. Problems with the feet, an Achilles tendon injury can result from flat feet, also known as fallen arches or overpronation. In this condition, the impact of a step causes the arch of your foot to collapse, stretching the muscles and tendons. Muscles or tendons in the leg that are too tight. Achilles tendon injuries are common in people who participate in the following sports. Running. Gymnastics. Dance. Football. Baseball. Softball. Basketball. Tennis. Volleyball. You are more likely to tear an Achilles tendon when you start moving suddenly. For instance, a sprinter might get one at the start of a race. The abrupt tensing of the muscle can be too much for the tendon to handle. Men older than age 30 are particularly prone to Achilles tendon injuries.
Symptoms
The pain from an Achilles tendon rupture is usually felt in the back of the lower leg, in the area 2 to 6 cm. above the Achilles tendon's attachment to the calcaneus. Individuals with an Achilles tendon rupture often describe a "pop" or similar feeling at the time of the injury. A "hole" or defect in the Achilles tendon can usually be felt under the skin in this area. A limp and inability to rise up on the toes of the affected foot are usually present. If the affected foot does not plantar flex when the calf muscles are squeezed an Achilles tendon rupture is very likely.
Diagnosis
During the clinical examination, the patient will have significantly reduced ankle plantar flexion strength on the involved side. When the tendon is palpated with one finger on either side, the tendon can be followed from the calcaneus to where it "disappears" in the area of the rupture and to where it then returns 2 to 3 cm proximal to the rupture. If the injury is recent, the patient indicates that her pain is localized at the site of the rupture. The defect eventually fills with blood and edema and the skin over the area becomes ecchymotic.
Non Surgical Treatment
There are two treatment options available which are non-operative and operative. Non-operative treatment involves the use initially of a below-knee plaster with the foot held fully bent downwards. This usually stays in place for 2 weeks then is changed for a brace(this is a boot from the knee down to the toes with Velcro straps) which should be worn day and night. The brace will be regularly altered to allow the foot to come up to a more neutral position. The brace will be on for a further 6 weeks. After the 8 weeks you will be referred for physiotherapy to regain movement and calf strength but will probably need to wear the brace during the day for a further 4 weeks. Non-operative treatment avoids the risks of surgery but the risk of the tendon re-rupturing, which normally occurs within 3 months of discarding the brace, is 10%.
Surgical Treatment
There are a variety of ways to repair an Achilles tendon rupture. The most common method is an open repair. This starts with an incision made on the back of the lower leg starting just above the heel bone. After the surgeon finds the two ends of the ruptured tendon, these ends are sewn together with sutures. The incision is then closed. Another repair method makes a small incision on the back of the lower leg at the site of the rupture. A series of needles with sutures attached is passed through the skin and Achilles tendon and then brought out through the small incision. The sutures are then tied together. The best surgical technique for your Achilles rupture will be determined by your orthopaedic foot and ankle surgeon.
The Achilles tendon is the soft tissue located in the heel which connects calf muscle to the heel bone allowing the body to perform certain activities such as rising on the tip toes and pushing off when running or walking. Achilles tendon tears occur when the tendon becomes torn through excessive pressure put on the area which the tendon is unable to withstand. Tears are most commonly found when suddenly accelerating from a standing position and therefore is often seen in runners and athletes involved in racquet sports. A tear can also occur when a continuous force is being put on the heel through prolonged levels of activity and overuse however this can also occur as a result of sudden impact or force to the area common in contact sports such as rugby and hockey. Although Achilles tendon tears can range in their severity, a rupture is the most serious form of tear and involves a completely torn tendon. This injury is more common in patients in their 30?s and 40?s.
Causes
An Achilles tendon injury might be caused by several factors. Overuse. Stepping up your level of physical activity too quickly. Wearing high heels, which increases the stress on the tendon. Problems with the feet, an Achilles tendon injury can result from flat feet, also known as fallen arches or overpronation. In this condition, the impact of a step causes the arch of your foot to collapse, stretching the muscles and tendons. Muscles or tendons in the leg that are too tight. Achilles tendon injuries are common in people who participate in the following sports. Running. Gymnastics. Dance. Football. Baseball. Softball. Basketball. Tennis. Volleyball. You are more likely to tear an Achilles tendon when you start moving suddenly. For instance, a sprinter might get one at the start of a race. The abrupt tensing of the muscle can be too much for the tendon to handle. Men older than age 30 are particularly prone to Achilles tendon injuries.
Symptoms
The pain from an Achilles tendon rupture is usually felt in the back of the lower leg, in the area 2 to 6 cm. above the Achilles tendon's attachment to the calcaneus. Individuals with an Achilles tendon rupture often describe a "pop" or similar feeling at the time of the injury. A "hole" or defect in the Achilles tendon can usually be felt under the skin in this area. A limp and inability to rise up on the toes of the affected foot are usually present. If the affected foot does not plantar flex when the calf muscles are squeezed an Achilles tendon rupture is very likely.
Diagnosis
During the clinical examination, the patient will have significantly reduced ankle plantar flexion strength on the involved side. When the tendon is palpated with one finger on either side, the tendon can be followed from the calcaneus to where it "disappears" in the area of the rupture and to where it then returns 2 to 3 cm proximal to the rupture. If the injury is recent, the patient indicates that her pain is localized at the site of the rupture. The defect eventually fills with blood and edema and the skin over the area becomes ecchymotic.
Non Surgical Treatment
There are two treatment options available which are non-operative and operative. Non-operative treatment involves the use initially of a below-knee plaster with the foot held fully bent downwards. This usually stays in place for 2 weeks then is changed for a brace(this is a boot from the knee down to the toes with Velcro straps) which should be worn day and night. The brace will be regularly altered to allow the foot to come up to a more neutral position. The brace will be on for a further 6 weeks. After the 8 weeks you will be referred for physiotherapy to regain movement and calf strength but will probably need to wear the brace during the day for a further 4 weeks. Non-operative treatment avoids the risks of surgery but the risk of the tendon re-rupturing, which normally occurs within 3 months of discarding the brace, is 10%.
Surgical Treatment
There are a variety of ways to repair an Achilles tendon rupture. The most common method is an open repair. This starts with an incision made on the back of the lower leg starting just above the heel bone. After the surgeon finds the two ends of the ruptured tendon, these ends are sewn together with sutures. The incision is then closed. Another repair method makes a small incision on the back of the lower leg at the site of the rupture. A series of needles with sutures attached is passed through the skin and Achilles tendon and then brought out through the small incision. The sutures are then tied together. The best surgical technique for your Achilles rupture will be determined by your orthopaedic foot and ankle surgeon.