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Medical Article

Achilles tendon injuries

Achilles tendon tear or rupture is an injury that affects the back of your lower leg. It most common among those who are engaged in recreational sports.

Achilles tendon is the largest tendon in your body. It is a strong fibrous cord that connects the gastrocnemius and the soleus, the two large muscles at the back of the calf, to your heel bone. This tendon and muscle combination help to anchor the leg, to stand on toes and to point the foot and ankle downward while walking and running.

The foot is dependent on the Achilles tendon for every movement. If you over stretch, your Achilles tendon can tear (rupture) completely or just partially. If your Achilles tendon ruptures, a ‘pop’ sound is heard, followed by an immediate sharp pain in the ankle and lower leg that is likely to affect your ability to walk properly. Surgery is often the best option to repair an Achilles tendon rupture. For many people, however, nonsurgical treatment works just as well.  The ruptures usually occur in people around the age group of 30 and 50 years

Symptoms of Achilles tendon rupture

Majority of ruptures occur about 4-6 cm above the heel. Sometimes the tendon can tear away from its point of insertion on the heel bone and, in doing so, is capable of pulling away a fragment of the heel bone.

Most common symptoms include:
Popping sound during injury
Severe pain and swelling near heel
Inability to bend injured foot downward
Inability to stand on toes of injured leg
In some people, the Achilles tear might show no signs or symptoms.
Causes and Risk Factors of Achilles Tendon Rupture

Ruptures are often caused by sudden increase in stress on your Achilles tendon. Increasing the intensity of sports participation, especially that involve jumping, falling from a height, stepping into a hole can lead to Achilles tendon tear.

Risk factors include:

Age – The peak age for  Achilles tendon rupture is 30 to 50.
Sex – Achilles tendon rupture is up to five times more likely to occur in men than in women.

Recreational sports- The majority of Achilles tendon injuries occur more frequently in those involved with sports mostly men because of their higher rates of participation in sport. Often sports related to running, jumping and sudden starts and stops-such as soccer, basketball and tennis.

Steroid injections – Injection of a steroid medicine is a common treatment for some tendon injuries. The use of steroid can weaken the tendons of the leg and ankle leading to rupture. Some specialists do suggest this treatment to help control pain.

Antibiotics - certain antibiotics such as ciprofloxacin (cipro) or levofloxacin (levaquin) increase the risk of Achilles tendon rupture.

Diagnosis of Achilles tendon

If you hear a popping sound at the back of the heel, apply some ice, keep your leg elevated and take emergency medical help.

During physical exam, the doctor will inspect the area of lower leg for tenderness and swelling. While palpating, the physician might feel a gap or interruption in the continuity of the tendon.

The doctor may ask you to kneel on a chair or lie on your stomach with your feet hanging over the end of the examination table. The doctor may then squeeze your calf muscle to see if your foot will automatically flex. If your tendon is ruptured, no movement will be detected.

To further analyze the nature of Achilles tendon injury your doctor may order an ultrasound or MRI scan. This procedure helps to take images of the tissues.

Treatment for Achilles tendon Rupture

The goal of treatment is to restore normal length and tension of the Achilles tendon, it often depends on the severity of injury, age and activity level. If you are young or middle aged, surgery will be recommended. Nonsurgical treatment should be the method of choice if you are older. Recent studies show that both the treatment choices are equally effective.

Surgical treatment
Surgery involves creating an incision at the back of the leg, mobilizing the two ends of the torn tendon and suturing them together. Surgery assures the correct apposition of the tendon ends, thus allowing patients to regain full strength, endurance, power and an early return to athletic activities.

Non surgical treatment
For this type of treatment you have to wear a cast or walking boot with wedges to elevate your heel, which allows your torn tendon to heal. This will help to avoid risks like infection related to surgery. In this method there is a longer recovery period and a higher incidence of re-rupture with conservative management. If re-rupture occurs, surgical repair may be more difficult.

Once healing is initiated, after surgical or nonsurgical treatment, the doctor will advise to undergo 2 months of supervised physical therapy and do exercises to strengthen the leg muscles and Achilles tendon. Six to four months will take for complete rehabilitation.