Achilles Tendon

posted on 19 Mar 2015 22:03 by romanticeyewitn76
Overview
Achilles Tendon The exact number of people who develop Achilles tendon injury is not known, because many people with mild tendonitis or partial tear do not seek medical help. It is believed to be more common in men but with the recent participation of women in athletics, the incidence of Achilles tendon injury is also increasing in this population. Overall, injury to the Achilles tendon is by far most common in the athlete/active individual.

Causes
A rupture occurs when a patient overstretches the Achilles tendon, an act which causes it to tear partially or completely. Achilles tendon ruptures can occur during athletic play or any time the tendon is stretched in an unexpected way.

Symptoms
Patients with an Achilles tendon rupture frequently present with complaints of a sudden snap in the lower calf associated with acute, severe pain. The patient reports feeling like he or she has been shot, kicked, or cut in the back of the leg, which may result in an inability to ambulate further. A patient with Achilles tendon rupture will be unable to stand on his or her toes on the affected side.

Diagnosis
On physical examination the area will appear swollen and ecchymotic, which may inhibit the examiners ability to detect a palpable defect. The patient will be unable to perform a single heel raise. To detect the presence of a complete rupture the Thompson test can be performed. The test is done by placing the patient prone on the examination table with the knee flexed to 90, which allows gravity and the resting tension of the triceps surae to increase the dorsiflexion at the ankle. The calf muscle is squeezed by the examiner and a lack of planar flexion is noted in positive cases. It is important to note that active plantar flexion may still be present in the face of a complete rupture due to the secondary flexor muscles of the foot. It has been reported that up to 25% of patients may initially be missed in the emergency department due to presence of active plantar flexion and swelling over the Achilles tendon, which makes palpation of a defect difficult.

Non Surgical Treatment
Non-surgical treatment of Achilles tendon rupture is usually reserved for patients who are relatively sedentary or may be at higher risk for complications with surgical intervention (due to other associated medical problems). This involves a period of immobilization, followed by range of motion and strengthening exercises; unfortunately, it is associated with a higher risk of re-rupture of the tendon, and possibly a less optimal functional outcome. Achilles Tendinitis

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.