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An Achilles Tendon Rupture How Do I Know I Have One?

Overview

The Achilles tendon attaches the calf muscles in the leg to the heel bone. It is the largest yet most exposed tendon in the body. An Achilles tendon rupture injury is when the tendon fibres tear, causing symptoms of pain and loss of function. A rupture can be either partial or complete and treatment may involve surgery. Achilles tendon rupture is most common in weekend athletes trying to train too hard and is least common in well-trained professional athletes. The injury is more common in men than in women and the frequency of rupture increases over the age of 30 years.


Causes
Repeated stress from a variety of causes is often the cause of Achilles tendon injury. The stress may occur from any of the following. Excessive activity or overuse. Flat feet. Poorly fitting or inadequate shoes. Inadequate warm-up or proper conditioning. Jogging or running on hard surfaces. Older recreational athlete. Previous Achilles tendon injury (tendonitis/rupture). Repeated steroid injections. Sudden changes in intensity of exercise. Use of fluoroquinolone antibiotics (especially in children). Trauma to the ankle. Tense calf muscles prior to exercise. Weak calf muscles.


Symptoms
Patients who suffer an acute rupture of the Achilles tendon often report hearing a “pop” or “snap.” Patients usually have severe pain the back of the lower leg near the heel. This may or may not be accompanied by swelling. Additionally, because the function of the Achilles tendon is to enable plantarflexion (bending the foot downward), patients often have difficulty walking or standing up on their toes.


Diagnosis
It is usually possible to detect a complete rupture of the Achilles tendon on the history and examination. A gap may be felt in the tendon, usually 4-5cm above the heel bone. This is the normal site of injury and is called an intra-substance tear. The tear can occur higher up about 10cm above the insertion into the heel at the site where the muscles join the tendon, this is known as a musculo-tendinous tear. A special test will be performed which involves squeezing the calf. Normally if the Achilles tendon is intact this causes the foot to point downwards but if it is ruptured it causes no movement. To confirm the diagnosis and the exact site of the rupture it may be necessary to perform an Ultra-sound or MRI scan.


Non Surgical Treatment
Two treatment options are casting or surgery. If an Achilles tendon rupture is untreated then it may not heal properly and could lead to loss of strength. Decisions about treatment options should be made on an individual basis. Non-surgical management traditionally is selected for minor ruptures, less active patients, and those with medical conditions that prevent them from undergoing surgery. The goal of casting is to allow the tendon to slowly heal over time. The foot and ankle are positioned to bring the torn ends of the tendon close together. Casting or bracing for up to 12 weeks or more may be necessary. This method can be effective and avoids some risks, such as infection, associated with surgery. However, the likelihood of re-rupture may be higher with a non-surgical approach and recovery can take longer.


Surgical Treatment
Surgery is recommended to those who are young to middle-aged and active. The ruptured tendon is sewn together during surgery. This is an outpatient procedure. Afterward the leg is put into a splint cast or walking boot. Physical therapy will be recommended. In about 4 to 6 months, healing is nearly complete. However, it can take up to a year to return to sports fully.

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