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Achilles Tendon Rupture Test

Overview

A tendon is a band of tissue that connects a muscle to a bone. The Achilles tendon runs down the back of the lower leg and connects the calf muscle to the heel bone. Also called the “heel cord,” the Achilles tendon facilitates walking by helping to raise the heel off the ground. An Achilles tendon rupture is a complete or partial tear that occurs when the tendon is stretched beyond its capacity. Forceful jumping or pivoting, or sudden accelerations of running, can overstretch the tendon and cause a tear. An injury to the tendon can also result from falling or tripping. Achilles tendon ruptures are most often seen in “weekend warriors”, typically, middle-aged people participating in sports in their spare time. Less commonly, illness or medications, such as steroids or certain antibiotics, may weaken the tendon and contribute to ruptures.


Causes
Your Achilles tendon helps you point your foot downward, rise on your toes and push off your foot as you walk. You rely on it virtually every time you move your foot. Rupture usually occurs in the section of the tendon located within 2.5 inches (6 centimeters) of the point where it attaches to the heel bone. This section may be predisposed to rupture because it gets less blood flow, which may impair its ability to heal. Ruptures often are caused by a sudden increase in the amount of stress on your Achilles tendon. Common examples include increasing the intensity of sports participation, falling from a height, stepping into a hole.


Symptoms
If you rupture your Achilles tendon, you may hear a snapping or popping sound when it happens. You will feel a sudden and sharp pain in your heel or calf (lower leg). It might feel like you have been kicked or hit in the back of your leg. You may also have swelling in your calf. be unable to put your full weight on your ankle, be unable to stand on tiptoe, or climb stairs, have bruising around the area. If you have any of these symptoms and believe you have ruptured your Achilles tendon, go straight to accident and emergency at your local hospital. If you partially rupture your Achilles tendon, the tear may only be small. Symptoms of pain and stiffness may come on quite suddenly like a complete rupture, but may settle over a few days.


Diagnosis
Most Achilles tendon ruptures occur in people between 30 and 50 years old and such injuries are often sport-related. If you suspect an Achilles injury, it is best to apply ice, elevate the leg, and see a specialist. One of the first things the doctor will do is evaluate your leg and ankle for swelling and discoloration. You may feel tenderness and the doctor may detect a gap where the ends of the tendon are separated. In addition to X-rays, the calf squeeze, or Thompson test, will be performed to confirm an Achilles tendon rupture. With your knee bent, the doctor will squeeze the muscles of your calf and if your tendon is intact the foot and ankle will automatically flex downward. In the case of a ruptured Achilles there will be no movement in the foot and ankle during the test.


Non Surgical Treatment
Medical therapy for a patient with an Achilles tendon rupture consists of rest, pain control, serial casting, and rehabilitation to maximize function. Ongoing debate surrounds the issue of whether medical or surgical therapy is more appropriate for this injury. Conservative management of Achilles tendinosis and paratenonitis includes the following. Physical therapy. Eccentric exercises are the cornerstone of strengthening treatment, with most patients achieving 60-90% pain relief. Orthotic therapy in Achilles tendinosis consists of the use of heel lifts. Nonsteroidal anti-inflammatory drugs (NSAIDs). Tendinosis tends to be less responsive than paratenonitis to NSAIDs. Steroid injections. Although these provide short-term relief of painful symptoms, there is concern that they can weaken the tendon, leading to rupture. Vessel sclerosis. Platelet-rich plasma injections. Nitric oxide. Shock-wave therapy.


Surgical Treatment
There are two different types of surgeries; open surgery and percutaneous surgery. During an open surgery an incision is made in the back of the leg and the Achilles tendon is stitched together. In a complete or serious rupture the tendon of plantaris or another vestigial muscle is harvested and wrapped around the Achilles tendon, increasing the strength of the repaired tendon. If the tissue quality is poor, e.g. the injury has been neglected, the surgeon might use a reinforcement mesh (collagen, Artelon or other degradable material). In percutaneous surgery, the surgeon makes several small incisions, rather than one large incision, and 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. For sedentary patients and those who have vasculopathy or risks for poor healing, percutaneous surgical repair may be a better treatment choice than open surgical repair.

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