Achilles Tendon Rupture Warning Signs

posted on 07 May 2015 01:24 by youngwhiz5598
Overview
Achilles Tendonitis The Achilles tendon is the largest and most vulnerable tendon in the body. It joins the gastrocnemius (calf) and the soleus muscles of the lower leg to heel of the foot. The gastrocnemius muscle crosses the knee, the ankle, and the subtalar joints and can create stress and tension in the Achilles tendon . Tendons are strong, but not very flexible so they can only so far before they get inflammed and tear or rupture.

Causes
People who commonly fall victim to Achilles rupture or tear include recreational athletes, people of old age, individuals with previous Achilles tendon tears or ruptures, previous tendon injections or quinolone use, extreme changes in training intensity or activity level, and participation in a new activity. Most cases of Achilles tendon rupture are traumatic sports injuries. The average age of patients is 29-40 years with a male-to-female ratio of nearly 20:1. Fluoroquinolone antibiotics, such as ciprofloxacin, and glucocorticoids have been linked with an increased risk of Achilles tendon rupture. Direct steroid injections into the tendon have also been linked to rupture. Quinolone has been associated with Achilles tendinitis and Achilles tendon ruptures for some time. Quinolones are antibacterial agents that act at the level of DNA by inhibiting DNA Gyrase. DNA Gyrase is an enzyme used to unwind double stranded DNA which is essential to DNA Replication. Quinolone is specialized in the fact that it can attack bacterial DNA and prevent them from replicating by this process, and are frequently prescribed to the elderly. Approximately 2% to 6% of all elderly people over the age of 60 who have had Achilles ruptures can be attributed to the use of quinolones.

Symptoms
Patients present with acute posterior ankle/heel pain and may give a history of ?felt like someone kicked me from behind?. Patients may report a direct injury, or report the pain started with jumping or landing on a dorsiflexed foot. It is important to elicit in the history any recent steroid or flouroqunolone usage including local steroid injections, and also any history of endocrine disorders or systemic inflammatory conditions.

Diagnosis
Your doctor diagnoses the rupture based on symptoms, history of the injury and physical examination. Your doctor will gently squeeze the calf muscles, if the Achilles tendon is intact, there will be flexion movement of the foot, if it is ruptured, there will be no movement observed.

Non Surgical Treatment
There are two treatment options available which are non-operative and operative. Non-operative treatment involves the use initially of a below-knee plaster with the foot held fully bent downwards. This usually stays in place for 2 weeks then is changed for a brace(this is a boot from the knee down to the toes with Velcro straps) which should be worn day and night. The brace will be regularly altered to allow the foot to come up to a more neutral position. The brace will be on for a further 6 weeks. After the 8 weeks you will be referred for physiotherapy to regain movement and calf strength but will probably need to wear the brace during the day for a further 4 weeks. Non-operative treatment avoids the risks of surgery but the risk of the tendon re-rupturing, which normally occurs within 3 months of discarding the brace, is 10%. Achilles Tendonitis

Surgical Treatment
Surgical correction of the ruptured tendon is almost always necessary. Surgery is performed in order to regain the maximum strength of the Achilles, as well as the normal pushing off strength of the foot. The strength of the muscle depends on the correct tension between the muscle and the tendon. The only way the correct tension on the tendon can set is by accurately repairing the tendon ends. When the tendon ruptures, the ends of the tendon separate and multiple little strands of the tendon are present like pieces of spaghetti. There are old fashioned techniques for repairing the tendon which require very long incisions (eight inches) on the back of the leg. These are complicated and associated with a high incidence of infection in the skin after surgery. This is an important consideration, since infection in the skin can lead to devastating problems with the skin and tendon. This problem of skin infection has, in the past, led surgeons away from surgical methods of treatment. Fortunately, now there is a new, unique method available for operating on and repairing the tendon. This new method requires only a tiny incision of one to two centimeters in length. This is far more accurate surgery. Recovery after this procedure is easier and the surgical complication rate is extremely low.