This often occurs in sports like basketball, tennis, or football. The symptoms of a rupture include an acute sharp pain in the back of the heel and inability to plantarflex the foot. The victim may remember hearing a snap when the injury occurred. Because there is an imbalance between the muscles that push the toes down and those that pull them up, walking becomes difficult with the pain and because the foot will drag.
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Sometimes the tendon does not fully rupture but only a partially tears. The symptoms are the same as a complete tear, and a partial tear can progress to a complete rupture. While the Achilles tendon rupture usually occurs near the insertion in the heel, it can occur at any location along the course of the tendon see picture 2. There are other causes of pain at the back of the heel than Achilles tendon rupture. It may be due to retrocalcaneal bursitis where inflammation occurs within the sac that cushions the tendon as it passes the bony edge of the heel bone.
Paratenonitis is inflammation of the tendon sheath that surrounds the length of the tendon. The treatment for bursitis and tenosis incorporates rest, exercise , and occasionally physical therapy. About 1 million athletes a year develop Achilles tendon inflammation or rupture. Achilles tendon rupture tends to occur in athletic people between ages 30 and 50 and mostly in men men:women. There may be an anatomy reason for the predominance of men. Achilles tendons in women have a smaller area and are thinner and may there may not be enough force generated to cause rupture.
Sports injuries refer to the kinds of injury that occur during sports or exercise. While it is possible to injure any part of the body when playing sports, the term sports injuries is commonly used to refer to injuries of the musculoskeletal system. What causes an Achilles tendon rupture?
Tendon never truly “heals,” it just gets patched (and you can’t rush it)
Underlying illness or disease may increase the risk of Achilles tendon injury. Examples include the following:. What are Achilles tendon rupture symptoms and signs? What tests help diagnose a ruptured Achilles tendon? A health care professional makes a diagnosis of Achilles tendon rupture by taking a patient's history and performing a physical exam as noted above. Imaging may be required to confirm the extent of tendon damage and to look for other associated injuries. Plain X-rays of the foot may reveal swelling of the soft tissues around the ankle, other bone injury, or tendon calcification.
Ultrasound is the next most commonly ordered test to document the injury and size of the tear. For a partial tear of the Achilles tendon, the diagnosis is not always obvious on a physical exam and an ultrasound may be considered. A health care provider or by an ultrasound technician and radiologist may perform a bedside ultrasound. MRI : Health care providers often order an MRI when a diagnosis of tendon rupture is not obvious on ultrasound or a complex injury is suspected.
MRI is an excellent imaging test to assess for presence of any soft-tissue trauma or fluid collection. More importantly, MRI can help detect presence of tendon thickening, bursitis, and partial tendon rupture. What are treatment options for an Achilles tendon rupture? Two options exist for Achilles tendon rupture, one involving surgical repair and the other a conservative treatment allowing the tendon to heal on its own in a cast.
Each has its benefits and risk and decisions will depend upon the patient's clinical situation, underlying medical background, the extent of the injury and the expectation of future activity. Surgery is the recommended treatment for the young, healthy and active individuals. For athletes, surgery is often the first choice of treatment.
The Achilles tendon can be repaired surgically by either a percutaneous or open technique. With the open technique, a physician makes an incision to allow for better visualization and approximation of the tendon. With the percutaneous technique, the surgeon makes several small skin incisions to repair the tendon. Irrespective of type of treatment, a health care professional will apply a short leg cast or postoperative boot on the operated ankle after completion of the procedure picture 3.
Each approach has its benefits and risks and the choice of surgery type is individualized for each specific patient. Disadvantages of a surgical approach include cost, the need for hospitalization and wound complications for example, skin sloughing, infection, sinus tract formation, nerve injury. Nonsurgical method may be recommended for patients who are older, less active, and have a higher risk for surgery and anesthetic.
Ability to heal wounds is also an important consideration and may include those with poor blood supply to their feet. These include patients with peripheral artery disease and diabetes. Nonsurgical management involves application of a short leg cast to the injured leg, with the foot in a slightly downward flexed position.
Cite article. The achilles tendon is the strong fibrous band that attaches the calf muscles to the calcaneus bone. A rupture of the achilles tendon ATR is a common pathology and it is the most commonly ruptured tendon in the human body. The main causes of a rupture can be overstretching of the heel during recreational sports, a forceful plantar flexion of the heel or a fall from an important height . The incidence is 7 per per year but goes up to 15 to 25 per per year for recreational athletes, with a peak incidence at the age of 30 to 50 years  .
An achilles tendon rupture occurs more frequently among men than women . It is common in stop-and-go sports such as badminton, soccer, volleyball, basketball, tennis, racquetball, squash as eccentric movement puts an enormous amount of stress on the tendon. There are some conditions that predispose to rupture, research suggests that injuries in this patient population are more likely to be missed on first examination  , these include:.
Three categories of indirect injury that may result in rupture are  :. In most of the available literature, an achilles tendon rupture is described as chronic if it occurs at least 4 to 6 weeks after injury .
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The symptoms of chronic achilles tendon rupture include pain, decreased strength, fatigue, and ankle stiffness. Achilles tendon tears may be grouped into 4 types, according to severity of the tear and degree of retraction:. The outcome measures used to evaluate functional results following an ATR can be broadly divided into two types:.
The best choice of outcome tools for reporting the results of treatment in patients with foot and ankle disorders remains uncertain and controversial. The SF has been proven useful in monitoring population health, estimating the burdens of different diseases, monitoring outcome in clinical practice, and evaluating medical treatment effects. Patient-reported outcome scales should be complemented by objective indicators of function, such as muscle strength   , calf muscle endurance  and return to previous activity level, in order to obtain a complete picture of the effect of the treatment .go
Achilles Tendon Stretches & Exercises for Tendonitis and More
When palpating along the entire length of the tendon, a gap may be present. In this part of the examination the therapist asks the patient to fulfil some active movements which can aid in the diagnosis of a tendon rupture. There is still considerable controversy as the most optimal treatment plan. Debate about nonoperative vs surgical repair for acute ruptures, minimally invasive vs traditional open repair, and early functional rehabilitation protocols instead of a more traditional rehabilitation program are only a few of the arguments that continue to exist in the realm of treatment.
Historically , intervention has been dependent on personal factors such as age, desire to return to sport and individual preference . Operative repair by sewing the torn ends of the injured achilles tendon together was considered to reduce risk of a future re-rupture but wound infection presented a possible complication such as scar adhesions, loss of sensation, DVT, and infection.
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Therefore younger persons were recommended to choose for the operative repair   and elderly and less active patients were recommended for a conservative approach with immobilisation in cast. Post surgically , early weight bearing and early ankle mobilisation is now widely accepted . However more recently, it has been demonstrated that a conservative and accelerated functional rehabilitation approach is more effective than a surgical approach  .
Wu et al  , showed that when functional rehabilitation was used, the effect of non-surgical intervention was similar to surgical treatment regarding the incidence of range of motion, a future chance of re-rupture, calf circumference and functional outcomes and also the incidence of other complications was reduced. It functions to transfer "push-off" force for the calf muscles to the heel bone.
Rupture of the Achilles tendon commonly occurs in individuals in their 30s, 40s, and early 50s, but no age group is immune. The underlying issue is that over time the tendon tends to become gradually weaker as the bodies ability to repair is overcome by the repetitive injury associated with activity. Rupture of the tendon usually occurs when an athlete loads the Achilles in preparation to pushing off.
Most commonly, this happens when a sudden, increased force is applied through the tendon. This can occur when changing directions, starting to run, stopping abruptly, jumping, or landing from a jump, Figure 2. Individuals will feel a sharp intense pain in the back of their leg. The rupture of the tendon can be extremely painful.
The injury is associated with a fair amount of swelling and later, discoloration. Immediately following the injury the pain varies a great deal. Some describe very little or no pain while others describe less but, persistent discomfort. While some individuals may be able to walk it is usually difficult. It is very rare that a rupture of the Achilles is partial.