Achilles tendon rupture: overview, cause, symptoms and treatment
A loud bang followed by pungent pain: The Achilles tendon is the strongest tendon of the human body, but it can also tear. Strong athletic stress, wear or a basic disease is considered as risk factors. If the tendon rupture is treated in time, the injury usually heals without complications – the performance can be restored.
In extreme situations, it is loaded with 15 times its own body weight, withstands great impact and tensile forces and gives us the ability to walk – the Achilles tendon. With a length of about ten to twelve centimetres, it is one of the largest and the strongest tendon of the body. They connect the bony heel bone (os calcaneus) with the calf muscle (Musculus Triceps Surae). This makes it possible for us to lower the tip of the foot downwards, for example, when the toe or toe is pressed.
But this tendon can also tear. Usually athletes are affected by an Achilles tendon rupture. Men between 30 and 50 years are the most common patients with this injury. Each year, there are around 10 of 100,000 people. The tendon usually tears in the less circumscribed central area, the so-called waist.
Cause of an Achilles tendon rupture: Abrupt movements under load
The biggest risk factor for a crack of the Achilles tendon is sport. Through abrupt movements, stops, sprints or directional changes enormous forces affect the physical structures of the movement apparatus. A healthy Achilles tendon, however, rarely tears: In most cases, damage to the tendon is already caused by minimal injuries – the smallest tearing in the tissue or irritation of the tendon.
The risk of injury also increases with the rising age of life: the tendon tissue loses its flexibility over the years and becomes more susceptible to damage. Often they are middle-aged men who want to intervene after an extended break in sporting events and strike a high intensity, which end up with an Achilles tendon rupture in the hospital. Especially reactive sports such as tennis, squash, handball, football or even gymnasts are risky.
Symptoms of an Achilles tendon rupture: toes are no longer possible
Usually an Achilles tendon rupture occurs during a stress point, ie during a short intermediate jump, a jump or a fast change of direction. Often a distinct whip-like bang is heard when the tendon ruptures. Affected persons usually feel as if someone is kicking their heels. There followed severe pain in the area of the heel and the calf.
Walking is not possible after a crack of the Achilles tendon, or only under severe, pungent pain. On the back of the ankle and on the calf swellings may occur. The “missing” tendon can in some cases be felt as a gap under the skin. A clear symptom of the injury is that the toe stand is no longer possible. A bruise can form in the area of the crack.
Tear, tear or achillodynia?
In addition to a complete tear of the Achilles tendon, other injuries can also trigger these symptoms. Achilles tend to speak of an achillodynia, when the Achilles tendon is constantly inflamed and irritated by tiny tears. The Achillodynia leads to chronic pain in the area of the tendon and can promote a crack.
If the Achilles tendon is only partially broken, there is an incomplete tear. In addition, the effect of the force and the abrupt movements can lead to a tear from the heel with bone parts. In this case, the tendon does not tear itself, but a piece of the heel bone breaks out and the tendon has no more support.
All three injuries may lead to similar symptoms.
Treatment of an Achilles tendon injury: PECH rule as an immediate measure
Immediately after the injury, the PECH rule should be used as the first treatment. That means:
P – pause: The activity should be stopped immediately (usually this is caused by the pain)
E – Ice: Cool the injured heel
C – Compression: A compression bandage can prevent a swelling
H – Elevation: The reflux of the blood is improved, the blood pressure on the injury is reduced.
The affected persons are usually looking for the emergency room of a hospital for an Achilles tendon rupture. If not, the walk to the orthopedic surgeon or accident surgeon is unavoidable.
Diagnosis Achilles tendon rupture: ultrasound brings clarity
With some examination methods, the orthopedic surgeon or accident surgeon will initially exclude other injuries or further damage to the movement apparatus. A thorough history (questioning the patient) is usually the first indication of an Achilles tendon rupture. The so-called Thompson test is a clear indication of a tendon tear. The patient lies lying on a couch, his feet hanging over. If the physician strongly compresses the calf muscle, the foot will automatically rise in the normal case (stretches away from the body, similar to the toe stand). With a severed Achilles tendon, this “reflex” remains out.
An ultrasound examination (sonography) clearly shows the developed gap between the tendon fragments to the physician. Here, a tear can usually be distinguished from a complete crack.
A magnetic resonance tomography (MRI) can give the physician a clearer picture of the remaining structures. This shows whether the ends of the string are frayed and how far apart the two pieces are. An X-ray image can show whether the bony heel has taken damage. All examinations help to filter the appropriate therapy.
Treatment Achilles tendon tear: fragments are sutured
If the Achilles tendon is torn, several treatment routes are possible. In young and healthy patients, surgery is usually the means of choice. In the minimally invasive procedure, the surgical tool is inserted via two cuts in the calf, and the two ends of the tendon are again sewn or glued together. The minimally invasive procedure may end in an open operation if the tendon fragments are far apart. It may also be that the tendon is not easy to sew or stick. Then the doctors strengthen the Achilles tendon with portions of the stiff muscular sheath or some other corporeal tendon.
The operation can be performed under general anaesthesia, regional anaesthesia or local anaesthesia. Regardless of the nature of the procedure, the patient must wear a stabilizing gypsum dressing for several weeks. The treatment is followed by a special support shoe with slightly elevated heel. This relieves the operated heel. Gradually, the height of the heel is reduced until the patient can go back to normal.
Alternative treatment: Conservative therapy without surgery
An operative procedure, however, does not have to be: A tear of the Achilles tendon can be treated conservatively. For elderly patients or those at whom surgery is a major risk, conservative treatment is a good alternative. As an immediate measure, we relieve the leg and stabilize it in a plaster for several weeks. The leg is fixed with the foot extended. Thus, the ends of the torn tendon are closer together and are easier to grow together again.
As in the case of an operating theater, a special shoe with an elevated heel follows the plaster bandage. Gradually, the height of the heel is reduced.
Which therapy is appropriate must be discussed with the treating physician. No patient resembles the other, and every Achilles tendon rupture is different, so no general statement can be made.
Post-injury prognosis: Full strength after one year
Whether after an operation or a conservative treatment: First, care is called for. For six to eight weeks the foot is fixed in the plaster or shoe and can only be easily loaded. It is important to start with the physiotherapy as soon as possible so that the musculature does not get stifled. Slight discomfort while walking or under load are normal in this phase. Even a shaky feeling on the legs can last for a long time.
After two or three months, the physician can usually start again with slight physical exercise. At the same time, those affected should not start with too much intensity in the training – the level of performance before the injury is not achieved at first. After half a year, the original condition should be restored. At the final examination, the doctor will ask the patient to put on the toes. If this is again possible without problems, the Achilles tendon rupture is considered as healed. Until this is the case, a whole year may pass. Problems in the everyday life or permanent damage leaves the injury usually not.
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