Achilles tendon rupture is a condition in which a (partially or completely) torn Achilles tendon has occurred. The Achilles tendon connects the calf muscles to the heel, allowing the sole of the foot to be brought closer to the back of the legs (such as when standing on the toes). The condition mainly occurs in athletic men and women, around the age of 30-40. This article discusses the history of the Achilles tendon and the complaints, diagnosis and treatment of a rupture.
Table of contents
- History and anatomy
- Complaints and increased risk
- Diagnostics
- Conservation treatment
- Surgical treatment
History and anatomy
The Achilles tendon (Lat: tendo calcaneus) forms the connection between the calf muscles (consisting of the gastrocnemius muscle and the soleus muscle) and the heel (Lat: calcaneus). It is approximately 15 cm in length, starts halfway down the lower leg and becomes narrower as it approaches the heel. The tendon was first described by the Flemish/Dutch pathologist Philip Verheyen in 1693.
The name derives from a myth about a hero named Achilles, from Greek mythology. According to this myth, he became inviolable by being immersed in the River Styx, during which his mother held him by his Achilles heel. Ultimately, during a war, he was hit by an arrow in this one vulnerable spot.
Complaints and increased risk
A tear in the Achilles tendon most often occurs when a sudden, violent strain is placed on this tendon. This is, for example, when suddenly standing up from a sitting position or suddenly jumping during a sport. At that moment this force is greater than the strength of the tendon. Complaints at the time they arise are often described as if someone stabs a knife in the heel or is given a kick from behind. After this, walking is virtually impossible and there is no longer any strength to stand on toes.
Risk factors for development are:
- Men have a 4 to 7 times increased risk of developing diabetes compared to women. It is unclear whether this is due to another form of sports practice or a primarily gender-dependent cause.
- Certain conditions involving reduced strength of connective tissue increase the risk of developing.
- Use certain antibiotics (particularly fluoroquinolones such as ciprofloxacin)
- An Achilles tendon rupture has an increased risk of recurrence
Thompson test performed, when squeezing both calves the left sole does not go down. So the left Achilles tendon is torn. / Source: Grook Da Oger, Wikimedia Commons (CC BY-SA-3.0)
Diagnostics
The most important things are the physical examination and the history of the disease, on this basis the diagnosis can usually be made. There is an inability to stand on the toes of the affected leg. A ‘delle’ is often palpable (indentation at the location of the interruption of the tendon). With the so-called Thompson test, the calf muscle is artificially shortened by squeezing it. With a normally functioning Achilles tendon, this results in a movement of the sole towards the back of the lower leg. If the Achilles tendon is broken, the sole will not respond. The Achilles tendon may also be partially torn. Often some function is still possible.
A second form of diagnosis is imaging. An ultrasound or MRI can provide an image of the course of the muscle and tendon. An interruption can be made visible here. This is particularly valuable in the case of an incomplete rupture.
Conservation treatment
This is mainly performed in the case of a partially torn Achilles tendon or in patients for whom surgery is a less attractive option, such as older age or comorbidity. A plaster cast is placed for a period of 6 to 8 weeks with the foot pointing downwards (pointed position), in order to bring the tendon parts as close together as possible. It takes approximately 10-12 weeks before normal activities can be undertaken, guidance can be provided by a physiotherapist. A complication may be that the tendon recovers in an extended position, as a result of which it no longer functions.
Surgical treatment
This procedure greatly reduces the risk of a new tear (approximately 3% versus 12% with conservative treatment). The tendon ends are connected to each other using sutures, which is a relatively minor procedure. The method of recovery and further management differs greatly per surgeon; in general, a plaster cast is given in a pointed position for 6 weeks. After two to three months the leg can bear normal weight. It is important to avoid stretching the tendon during the recovery period.
