Pain of the Achilles tendon commonly affects both competitive and recreational athletes, and the sedentary. The largest tendon in the body, the Achilles tendon, endures strain and risks rupture from running, jumping, and sudden acceleration or deceleration. Overuse, vascular diseases, neuropathy, and rheumatologic diseases may cause tendon degeneration. The hallmarks of Achilles tendon problems seem to be damaged, weak, inelastic tissue.
Causes of and contributors to Achilles tendon rupture include trauma (caused by injury, usually an acceleration injury such as pushing off or jumping up). Preceding tendon problems. Chronic Achilles tendonitis (can lead to small tears within the tendon, increasingly weakening it). Certain drug therapies/treatments. Drugs that have been linked to Achilles tendon rupture include. Fluoroquinolone antibiotics - after nearly 900 reports of tendon ruptures, tendonitis and other tendon disorders (most associated with the Achilles tendon) linked to Ciprofloxacin (Cipro) alone were collected in the U.S. Food and Drug Administration (FDA)?s database, at least one public-interest group petitioned the FDA to recommend that a "Black Box Warning" be added to Cipro's packaging. Some researchers speculate this class of antibiotics is toxic to tendon fibers, and that in some cases may reduce their blood supply. Patients should at least be more aware of the potential for ruptures so that they can be switched to other antibiotics at the onset of early warning signals such as tendon pain.
You may notice the symptoms come on suddenly during a sporting activity or injury. You might hear a snap or feel a sudden sharp pain when the tendon is torn. The sharp pain usually settles quickly, although there may be some aching at the back of the lower leg. After the injury, the usual symptoms are as follows. A flat-footed type of walk. You can walk and bear weight, but cannot push off the ground properly on the side where the tendon is ruptured. Inability to stand on tiptoe. If the tendon is completely torn, you may feel a gap just above the back of the heel. However, if there is bruising then the swelling may disguise the gap. If you suspect an Achilles tendon rupture, it is best to see a doctor urgently, because the tendon heals better if treated sooner rather than later.
The diagnosis is usually made on the basis of symptoms, the history of the injury and a doctor's examination. The doctor may look at your walking and observe whether you can stand on tiptoe. She/he may test the tendon using a method called Thompson's test (also known as the calf squeeze test). In this test, you will be asked to lie face down on the examination bench and to bend your knee. The doctor will gently squeeze the calf muscles at the back of your leg, and observe how the ankle moves. If the Achilles tendon is OK, the calf squeeze will make the foot point briefly away from the leg (a movement called plantar flexion). This is quite an accurate test for Achilles tendon rupture. If the diagnosis is uncertain, an ultrasound or MRI scan may help. An Achilles tendon rupture is sometimes difficult to diagnose and can be missed on first assessment. It is important for both doctors and patients to be aware of this and to look carefully for an Achilles tendon rupture if it is suspected.
Non Surgical Treatment
There is no definitive protocol for conservative management. Traditionally, conservative treatment involved immobilisation in a cast or boot, with initial non-weight bearing. Recently, good results have been achieved with functional bracing and early mobilisation, and it is common to be immediately weight-bearing in an orthotic. Conservative management reduces the chance of complications, such as infection. There is a risk the tendon can heal too long and more slowly.
Your doctor may recommend surgery if you?re young and active, or an athlete. However, this will depend on where your tendon is ruptured. If the rupture is at, or above, the point at which your tendon merges with your calf muscle, for example, surgery may not be possible. There are three main types of surgery to repair a ruptured Achilles tendon. Open surgery. Your surgeon will make one long cut in your leg to reach the tendon and repair it. Limited open surgery. Your surgeon will still make a single cut but it will be shorter. Percutaneous surgery. Your surgeon will make a number of small cuts to reach the tendon and repair it. In all types of surgery, your surgeon will stitch the tendon together so it can heal. Each type of surgery has different risks. Open surgery is less likely to injure one of the nerves in your leg for example, but has a higher risk of infection. Ask your surgeon to explain the risks in more detail. After your operation, you will need to wear a series of casts or an adjustable brace on your leg to help your Achilles tendon heal. This will usually be for between four and eight weeks. There is a chance that your tendon will rupture again after the operation.
Here are some suggestions to help to prevent this injury. Corticosteroid medication such as prednisolone, should be used carefully and the dose should be reduced if possible. But note that there are many conditions where corticosteroid medication is important or lifesaving. Quinolone antibiotics should be used carefully in people aged over 60 or who are taking steroids.