Coleen Barkle
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What Are The Causes Of A Ruptured Achilles Tendon?



Overview
Achilles Tendonitis
The Achilles tendon is the large cord like structure on the back of the leg just above the heel. It is the largest tendon in the body and has a tremendous amount of force transmitted through it during walking, running and jumping activities. The Achilles tendon is prone to injury, including rupture during periods of increased stress and activity. Common activities causing injury include running, basketball, baseball, football, soccer, volleyball and tennis. These activities require jumping and pushing forces that are possible due to the strength of the calf musculature and the ability of the Achilles tendon to endure this stress. Men from the ages of 30-50 are the most commonly injured during weekend athletic activities.

Causes
As with any muscle or tendon in the body, the Achilles tendon can be torn if there is a high force or stress on it. This can happen with activities which involve a forceful push off with the foot, for example, in football, running, basketball, diving, and tennis. The push off movement uses a strong contraction of the calf muscles which can stress the Achilles tendon too much. The Achilles tendon can also be damaged by injuries such as falls, if the foot is suddenly forced into an upward-pointing position, this movement stretches the tendon. Another possible injury is a deep cut at the back of the ankle, which might go into the tendon. Sometimes the Achilles tendon is weak, making it more prone to rupture. Factors that weaken the Achilles tendon are as follows. Corticosteroid medication (such as prednisolone) - mainly if it is used as long-term treatment rather than a short course. Corticosteroid injection near the Achilles tendon. Certain rare medical conditions, such as Cushing's syndrome, where the body makes too much of its own corticosteroid hormones. Increasing age. Tendonitis (inflammation) of the Achilles tendon. Other medical conditions which can make the tendon more prone to rupture; for example, rheumatoid arthritis, gout and systemic lupus erythematosus (SLE), lupus. Certain antibiotic medicines may slightly increase the risk of having an Achilles tendon rupture. These are the quinolone antibiotics such as ciprofloxacin and ofloxacin. The risk of having an Achilles tendon rupture with these antibiotics is actually very low, and mainly applies if you are also taking corticosteroid medication or are over the age of about 60.

Symptoms
The classic sign of an Achilles' tendon rupture is a short sharp pain in the Achilles' area, which is sometimes accompanied by a snapping sound as the tendon ruptures. The pain usually subsides relatively quickly into an aching sensation. Other signs that are likely to be present subsequent to a rupture are the inability to stand on tiptoe, inability to push the foot off the ground properly resulting in a flat footed walk. With complete tears it may be possible to feel the two ends of tendon where it has snapped, however swelling to the area may mean this is impossible.

Diagnosis
During the clinical examination, the patient will have significantly reduced ankle plantar flexion strength on the involved side. When the tendon is palpated with one finger on either side, the tendon can be followed from the calcaneus to where it "disappears" in the area of the rupture and to where it then returns 2 to 3 cm proximal to the rupture. If the injury is recent, the patient indicates that her pain is localized at the site of the rupture. The defect eventually fills with blood and edema and the skin over the area becomes ecchymotic.

Non Surgical Treatment
Non-surgical treatment typically involves wearing a brace or cast for the first six weeks following the injury to allow time for the ends of the torn tendon to reattach on their own. Over-the-counter medications, such as ibuprofen or aspirin, may be taken during this time to reduce pain and swelling. Once the tendon has reattached, physical therapy will be needed to strengthen the muscles and tendon. A full recovery is usually made within four to six months.
Achilles Tendinitis

Surgical Treatment
There are two types of surgery to repair a ruptured Achilles tendon. In open surgery, the surgeon makes a single large incision in the back of the leg. In percutaneous surgery, the surgeon makes several small incisions rather than one large incision. In both types of surgery, the surgeon sews the tendon back together through the incision(s). Surgery may be delayed for about a week after the rupture, to let the swelling go down.
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