Achilles tendon rupture is when the achilles tendon breaks. The achilles is the most commonly injured tendon. Rupture can occur while performing actions requiring explosive acceleration, such as pushing off or jumping. The male to female ratio for Achilles tendon rupture varies between 7:1 and 4:1 across various studies.Causes
The Achilles tendon is a strong bands of fibrous connective tissue that attaches the calf muscle to the heel bone. When the muscle contracts, the tendon transmits the power of this contraction to the heel bone, producing movement. The Achilles tendon ruptures because the load applied to it is greater than the tendon's ability to withstand that load. This usually occurs as a result of a sudden, quick movement where there is a forceful stretch of the tendon or a contraction of the muscles eg: jumping, sprinting, or pushing off to serve in tennis. This occurs most often in sports that require a lot of stopping and starting (acceleration-deceleration sports) such as tennis, basketball, netball and squash. The Achilles tendon is on average 15cm in length. Most ruptures occur 2-6cm above where the tendon inserts into the heel bone. This is the narrowest portion of the Achilles tendon and is also the area with the poorest blood supply. achilles tendon rupture is most common when the muscles and tendon have not been adequately stretched and warmed up prior to exercise, or when the muscles are fatigued. the Achilles tendon has a poor blood supply, which makes it susceptible to injury and slow to heal after injury. During exercise the amount of blood able to travel to the tendon is decreased, further increasing the risk of rupture. Most experts agree that there are no warning signs of an impending rupture. However, frequent episodes of Achilles tendonitis (tendon inflammation) can weaken the tendon and make it more susceptible to rupture.
Symptoms
Ankle pain and swelling or feeling like the ankle has ?given out? after falling or stumbling. A loud audible pop when the ankle is injured. Patients may have a history of prior ankle pain or Achilles tendonitis, and may be active in sports. Swelling, tenderness and possible discoloration or ecchymosis in the Achilles tendon region. Indentation above the injured tendon where the torn tendon may be present. Difficulty moving around or walking. Individual has difficulty or is unable to move their ankle with full range of motion. MRI can confirm disruption or tear in the tendon. Inability to lift the toes.
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
You may need to wear a plaster cast, brace or boot on your lower leg for six to eight weeks to help the tendon heal. During this time, your doctor will change the cast a number of times to make sure your tendon heals in the right way. If your tendon is partially ruptured, your doctor will probably advise you to have this treatment instead of surgery. It?s also suitable for people who aren't very physically active. However, there is a greater risk that your tendon will rupture again, compared with surgery. Your doctor will advise you which treatment is best for you.
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.