An Achilles tendon rupture (Achilles tendon rupture) is often accompanied by a whip-like bang. The patient can no longer stand on the toes of the affected foot. A doctor can usually already draw conclusions about the cause – Achilles tendon rupture – from these symptoms. The tear usually needs to be treated surgically. Read all important information about symptoms, diagnosis and treatment of an Achilles tendon rupture!
Achilles tendon tear: Description
The Achilles tendon tear is not a rare injury. More than ten out of 100,000 people suffer annual Achilles tendon rupture. Men are more affected than women. Typically, an Achilles tendon rupture occurs between the ages of 20 and 50 years. Most of the Achilles tendon tears in the poorly perfused middle area and more rarely on the bone or muscle attachment.
The Achilles tendon connects the calf muscle “Musculus Triceps Surae” with the heel bone. The M. triceps surae allows us to lower the tip of the toe (for example, when pressing the accelerator pedal in the car or walking on tiptoe). The Achilles tendon has a length of ten to twelve centimeters and is the strongest tendon of the body: it is loaded in maximum situations with ten times the body weight.
Achilles tendon tear: symptoms
If the Achilles tendon is torn, quite typical symptoms appear. Those affected report a sudden snap or a whip-like bang, followed by a sharp stabbing pain above the heel. Walking is much more difficult. Above all, no toe walk is possible anymore.
Swelling on the back of the ankle and calf may also indicate an Achilles tendon tear. Sometimes a bruise can be seen above the heel.
Achilles tendon tear: causes and risk factors
Most often, an Achilles tendon tear is caused by abrupt strong tensioning of the tendon. Typical risk sports are football, sprinting, badminton, basketball, tennis and squash activities that require quick stop-and-go movements, sprints and sometimes jumps. As a rule, the affected tendon is already damaged – for example by aging processes or by micro-injuries as a result of over-exercise and lack of training breaks. For example, risk factors for Achilles tendon rupture are:
- older age
- Muscle malfunctions
- male gender
- Taking (quinolone) antibiotics, anabolic steroids and cortisone
In addition, bad footwear, deviations of the foot axis and foot deformities favor an Achilles tendon tear.
In more than 70 percent of cases, an Achilles tendon tear occurs in the mid-region of the tendon, where blood circulation is the worst there. This also hampers healing.
Achilles tendon tear: examinations and diagnosis
The specialists for an Achilles tendon tear (and other tendon tears) are orthopedic surgeons and accident surgeons. The acute symptoms cause most people to go to an emergency room immediately.
First, the attending physician will ask you various questions like:
- Can you walk normally?
- Did the symptoms come on suddenly?
- How did the accident happen?
- Have you ever experienced something similar?
First, blood flow, sensitivity and motor function in the lower leg and foot area have to be examined. In addition, the doctor scans the Achilles tendon: A Achilles tendon tear, a gap can be felt.
An important study in suspected Achilles tendon rupture is the so-called Thompson test. For this, the patient lies prone on a couch. His feet hang freely over the edge of the lounger. The doctor then squeezes the calf muscles of the affected leg together vigorously, with the foot normally extending down the sole of the foot. In an Achilles tendon rupture, this plantarflexion will be absent – the foot will not move.
Imaging procedures
To ensure the diagnosis, an ultrasound examination is performed. This allows the clinician to determine the rupture site, determine how far the tendon ends are from each other, and whether bruising has developed. In addition, he can check whether the tendon sheath is preserved as a guide rail.
In certain cases, magnetic resonance imaging (MRI) is performed, such as unclear findings, chronic complaints and repeated ruptures. This study is more accurate than sonography and therefore reveals discrete structural changes. Typically, the muscular end of the Achilles tendon has a corkscrew-like appearance on a tear and the foot-mounted end has a hump. In the area of the tear fluid can usually be detected.
An X-ray examination is useful in suspected bony involvement.
differential diagnosis
Alternative diagnoses include torn muscle fibers or tendinitis. If you have a dysphagia it must also be considered that it can be a so-called S1 syndrome. An S1 syndrome is caused by the irritation of a nerve root of the spinal cord to the rump.
Achilles tendon tear: treatment
Emergency treatment at the scene of the accident can be carried out in accordance with the “PECH” rule: break, ice, compression, elevation.
Conservative treatment
If the two ends of the Achilles tendon can be brought together in a foot lowering (Spitzfußstellung, plantarflexion) (control in the ultrasound), can be treated conservatively. For this purpose, the patient receives a lower leg plaster in equinus position for two weeks. After that he has to wear a shoe orthotic for six weeks, which means a specially adapted shoe that is raised in the heel area. This steepness of the foot is successively reduced.
surgery
An operation has the advantage that it is less likely to rupture again and the tendon is then more resilient and functional than after conservative treatment. However, especially minor surgery complications may occur.
The surgery can be either open or minimally invasive. Normally, the two tendon ends are sewn together. However, if the tendon quality in the area of the tear is very poor (for example due to wear), the surgeon must either use special suture techniques (such as pencil box plastic surgery) or work in a piece of tendon from another body site (such as the sole of the foot).
General anesthesia is not mandatory – surgery can often be performed with regional or even local anesthesia. The patient must be stored in a prone position with his feet down for prone surgery. The surgeon must always compare both feet during surgery to get the best results. In all surgical procedures, attention must be paid to the nearby sural nerve so that it is not injured. This nerve is about 10 to 15 centimeters from the heel bone on the lower leg on the outer side of the Achilles tendon.
After surgery, the patient must wear a lower leg cast in equinus position for four to six weeks. After two weeks, the steepness is reduced.
In all cases, early treatment must be started.
Achilles tendon tear: Disease course and prognosis
The prognosis for an Achilles tendon tear is very good with proper care. In rare cases infections, circulatory disorders and / or shortening or lengthening of the tendon may occur.
Both after conservative and surgical therapy a post-treatment of several months is necessary. Thus, the tendon in physiotherapy is increasingly burdened. Three to four months after the Achilles tendon rupture normal physical activity is possible again. Competitive athletes, on the other hand, should wait about half a year before they start competing again.
Some patients suffer from one Achilles tendon injury of chronic pain.