Torn Achilles tendonThe Achilles tendon is the attachment tendon of the triceps surae muscle of the calcaneus. The task of the muscle or tendons is to pull the heel upwards and thus to lower the foot. This movement is essential when running and walking.
The Achilles tendon is the strongest tendon in the human body. It has a length of 10-12 cm and a diameter of 0.5-1 cm. An Achilles tendon rupture is a tear or tear of the Achilles tendon following the calf, caused by a traumatic or atraumatic event.
In principle, a distinction is made between traumatic and atraumatic ruptures of the Achilles tendon. Traumatic ruptures: Traumatic ruptures are mostly sports accidents and injuries. In some cases, the tendon is also torn or torn during normal walking and running.
In most cases, a traumatic rupture of the Achilles tendon is caused by a sudden stopping movement, which results in a sudden pull on the Achilles tendon. In everyday life, a rupture can occur when walking downhill or when the foot is bent. In the field of sports, this type of injury usually occurs in the many ball sports.
Here, ball sports are particularly affected, where speed and often changing running directions and speeds are required. Tennis or table tennis as well as basketball should be mentioned here. Ruptures of the Achilles tendon occur relatively rarely in handball or football and are usually associated with kicks by the opponent into the area of the Achilles tendon.
The causes of traumatic ruptures of the Achilles tendon lie in a tension or sudden increase in pressure or overstretching of the ankle. The Achilles tendon can then no longer withstand the load despite its stability and tears. It is often the case that torn tendons are already pre-damaged and thinned out, so a minor trauma is necessary to cause the tendon to tear.
Atraumatic ruptures:Atraumatic ruptures do not result in an accident but in a sudden, unexpected tearing and tearing of the Achilles tendon. In all cases, the atraumatic rupture is based on previous damage or degenerative processes. Even the atraumatic rupture does not occur just like that, but rather during movements that put stress on the Achilles tendon.
A stop (even a slight stop) or going downhill can lead to a rupture of the tendon. Furthermore, the Achilles tendon ruptures are subdivided into complete ruptures, where a rupture occurs about 2-6 cm above the heel bone, and the rather rare partial rupture. Complete tears directly at the heel bone occur very rarely.
There are numerous risk factors that can promote an Achilles tendon rupture. In addition to chronic overloading, in which the tendon is already pre-damaged and the smallest undetectable tears reduce the stability of the tendon, gout (increase in the level of uric acid in the blood) and rheumatoid arthritis are among the risk factors for an Achilles tendon rupture. There are also drugs that can make the Achilles tendon more susceptible to ruptures.
The long-term use of cortisone on the one hand, but also immune-suppressing drugs lead to an increased tensile strength of the tendon. The risk of rupture of the Achilles tendon is also attributed to some antibiotics. In this context, antibiotics from the group of gyrase inhibitors should be mentioned above all.
The drug causes are rather rare compared to the traumatic causes. A complete Achilles tendon rupture is often described as a loud whip-like noise, which is due to the fact that the severely tensed Achilles tendon tears and straps upwards. During the rupture, severe pain is also described, but this quickly subsides afterwards.
Above the point of attachment of the tendon one usually finds a palpable dent, which is based on the fact that the muscle also buzzes together. A short time after the rupture a swelling (edema) may occur. In addition, there may also be bleeding in the area of the rupture, which becomes visible through a haematoma.
After the rupture, the impaired movement is the leading symptom. In most cases, the foot can no longer be bent downwards. Lifting the foot, on the other hand, does not usually cause any problems.
In order to diagnose an Achilles tendon rupture, it is often sufficient to simply look at the patient. Classic movement impairment and a typical dent above the insertion point often indicate an Achilles tendon rupture. The patient is always asked about the event that took place and whether there was a whip-like noise.
The physical examination consists of palpation and passive and active movement of the foot. In the so-called Thompson test, the calf is compressed while the patient is lying down. If the foot does not move as a result, an Achilles tendon rupture is probable.
Ultrasound is the most important imaging method. A gap in the area of the Achilles tendon can be seen, which corresponds to a rupture. In some cases, an additional MRI of the Achilles tendon may be necessary to better assess the injury.
Today, conservative therapy is increasingly used. It consists of immobilising the leg in the pointed foot position. This is usually done with a special shoe.
The prerequisite is that the ends of the tendon lie against each other and thus have the chance to grow together. The immobilization should be done 24 hours a day for 6 weeks, then another 2 weeks with a wearing time of about 12 hours a day. In the past, surgical treatment was almost always performed.
Today, there is rarely an indication for this. During surgery, the tissue is opened at the side of the Achilles tendon, the two tendon attachments are placed together and sutured again. A lengthy immobilization of the foot by means of a plaster cast or special shoe follows even after an operation.
Men are affected about 5 times more often than women. The main age of a rupture is between 30 and 50 years and then again above 50 years of age. About 20 people per 100,000 inhabitants suffer an Achilles tendon rupture per year.
A rupture of the Achilles tendon can either be traumatic, e.g. after a sports accident (sudden stop) or atraumatic (mostly degenerative). The typical symptoms are Diagnosed is a rupture by questioning (whip-like noise), examination (movement impairment) and by imaging using ultrasound (free space at the tendon site indicates a rupture)Today, therapy is almost only conservative (immobilization of the foot in pointed position in a special shoe for 6 weeks 24 hours, then for 2 months 12 hours, then build-up training. – whip-like buckling
- Impairment of movement (the foot can no longer be brought into the pointed foot position).