Pathogenesis (development of disease)
The Achilles tendon (tendo calcaneus) is the end tendon of the three-headed calf muscle (from musculus soleus and musculus gastrocnemius) that attaches to the heel. The Achilles tendon is the strongest tendon in the human body (it can support up to 25 times the body weight for a short time). Achilles tendon rupture is often located a few centimeters above the attachment.
The rupture is caused by acute trauma in the case of degenerative previous damage or repetitive microtrauma. Thus, there is an acute or chronic overload of the stress limit of the tendon.
Etiology (causes)
Biographic causes
- Genetic burden
- Genetic diseases
- Ehlers-Danlos syndrome (EDS) – genetic disorders that are both autosomal dominant and autosomal recessive; heterogeneous group caused by a disorder of collagen synthesis; characterized by increased elasticity of the skin and unusual tearability of the same (habitus of the “rubber man”).
- Familial hypercholesterolemia (FH) – genetic disease with autosomal recessive inheritance; hyperlipoproteinemia (HLP) characterized by significantly elevated serum cholesterol.
- Cerebrotendinous xanthomatosis (CTX) – genetic disease with autosomal recessive inheritance; lipid storage disease; first clinical symptom cholestasis and/or chronic diarrhea in infancy; furthermore, cataract may develop.
- Genetic diseases
- Age – active men between the ages of 30 and 40 are particularly likely to be affected.
Behavioral causes
- Incorrect footwear
- Lack of training condition or incorrect training.
- Sports with sprints and rapid deceleration as in squash, etc.
- Overexertion
Disease-related causes
Endocrine, nutritional and metabolic diseases (E00-E90).
- Diabetes mellitus (diabetes).
Musculoskeletal system and connective tissue (M00-M99).
- Inflammatory rheumatic diseases, unspecified.
- Foot deformities
Laboratory diagnoses – laboratory parameters that are considered independent risk factors.
- Hypercholesterolemia
Medication
- Anabolic steroids
- Quinolones/fluoroquinolones/gyrase inhibitors (ciprofloxacin, moxifloxacin, nalidixic acid, norfloxacin, lomefloxacin, levofloxacin, ofloxacin).
- Immunosuppressants
- Previous intra- and paratendinous (“inside and around the tendon”) injections of glucocorticoids.
Other causes
- Immobilization
- Poor substrate
