OVERVIEW

An injury to the Achilles tendon is a very common form of injury among athletes. Due to its position, intense pressure caused by strenuous physical activities can lead to its rupture. The Achilles tendon is a tough connective tissue that connects muscles from the back of the leg to the calcaneus also known as the heel bone.

The Achilles tendon is also known as the calcaneal(heel) tendon. It is the largest and toughest tendon in the human body. Rupture of the Achilles tendon mostly but not always cause severe pain and inflammation at the heel side and the lower part of the leg. The diagnosis of the tendon rupture is by physically examining and radiological images like; X-ray, MRI, and others. Upon diagnosis by a physician, treatment is either surgical or nonsurgical.

DEFINITION 

Achilles tendon rupture refers to tear or break of the Achilles tendon whether partly or completely. The Achilles tendon rupture is also called Achilles tendon tear.

CAUSES

The tear or rupture of the Achilles tendon occurs due to increased tension and stress bound its tensile capacity.

  1. Strenuous activities like sports that put unbearable tension on the Achilles tendon.
  2. A fall from a considerable height.
  3. Situations that overstretch the tendon; like falling into a hole or a trench.

pathophysiology

Rupture of the Achilles tendon occurs due to stress and tension on the tendon. Basically, the tendon is fortified by collagen giving it the ability to withstand stress and tension from stretching it.

Old age, chronic use of steroids, use of fluoroquinolone, and medical conditions like rheumatoid arthritis can lead to the destruction of vascular connective tissues, destruction of collagen, and inhibition of collagen synthesis all resulting to decreased strength of the tendon.

In addition to the destruction of collagen, the blood supply of the tendon is not that much hence the destruction of blood vessels supplying the tendon cause atrophy and weakness of the tendon. Due to this weakness, any activity which puts enough stress on the tendon can cause a tear or rupture of it. Also, the most common location of rupture is a demarcated area which is 3cm to 6cm below the heel-bone, this area has a poor blood supply. Hence, healing is delayed.

RISK FACTORS

1. Being a male.
2. Age around 30 to 40.
3. Obesity.
4. Being an athlete or a sportsperson.
5. A previous history of Achilles rupture.
6. Abuse or chronic use of steroids.
7. Continual usage of certain antibiotics specifically; fluoroquinolone.
8. Weakened calf muscles.
9. Medical conditions like; Rheumatoid arthritis which can destroy collagen.

Epidemiology 

Rupture of the Achilles tendon is a very common injury among athletes and sportsmen. It is the most common tendon in the human body which frequently gets torn due to the extent of stress it is exposed to.

It is more prevalent among middle-aged men around the ages of 30 to 40 who are sportsmen or engage in any strenuous activities that expose tension above the maximal tensile strength of the Achilles tendon. Annually, the incidence of Achilles tendon rupture increases. In the year 1981, the annual ratio of cases recorded in favour of Achilles tendon rupture was about 5:100,000 and this increased to 6:100,000 in the year 1994 all in Scotland. Generally, about 1 out of every 5000 people has an Achilles tendon rupture.

Apart from strenuous activities like athletics and sportsmanship, other daily lifestyle activities can cause rupture or predispose people to rupture of the Achilles tendon. Some of these activities are the chronic injection of steroids and the use of fluoroquinolone.

In addition to these; Achilles tendon rupture can be found mostly in people with conditions that destroy collagen by preventing blood supply to the tendon due to vascular damages. Some of these conditions are Rheumatoid arthritis, Systemic lupus erythematosus.

CLINICAL MANIFESTATIONS

1. Pain in the area of injury.
2. A possible swelling in the injured leg.
3. Inability to stand on the injured leg.
4. Limping when walking.
5. A sharp explosive sound (Popping sound) when the injury occurs.

COMPLICATIONS

1. Chronic Pain.
2. Reoccurrence of injury.
3. Permanent disability due to lack of treatment or inability to heal.
4. Stress and reduced input at work.

DIAGNOSIS

1. Physical examinations and medical history.

a) The physician will check for swelling, redness and elicit pain sensation.
b) The physician will check for a gap between the tendon to determine the extent of the rupture.
c) The doctor pulls the calf muscle to check for a corresponding flexion of the extended leg whiles patient lies in a prone position. An absence of the flexion shows a possible Achilles tendon rupture.

2. Imaging.

a) X-ray.
b) MRI to confirm the extent of the tear(partial or complete).

PROGNOSIS

Achilles tendon rupture will not lead to serious complications when treated well and early. If the tear is treated early, people recover to their normal activities within a period of about 5 months to a year. It is sometimes very difficult for people who have a pre-existing disease that destroys collagen and also for people who abuse steroids and other drugs to achieve a quick and complete recovery.

These people may have recovery but the duration may be a little longer. The extent of rupture also depicts the duration of recovery or even the ability of a total recovery. If the rupture is left untreated recovery becomes very difficult to heal completely and symptoms may not even subside.

PREVENTION

1. Reduce the abuse of steroids and other drugs.
2. Eat healthy diets.
3. Maintain reasonable body weight.
4. Maintain the strength of calf muscles.
5. Avoid over strenuous activities.
6. Exercise regularly.

TREATMENT

1. Non-surgical; Mostly this is done for partial ruptures of the tendon. A patient through these procedures;

a. Resting.
b. Icing.
c. Compression with bandages to reduce additional swelling due to the movement of the tendon.
d. Elevation of the injured leg.

2. Drug therapy; Pain relievers (NSAIDs and other drugs).

3. Surgery; Mostly done to repair the tendon in a complete rupture.

SUMMARY

Achilles tendon is the thickest and toughest tendon in the human body. It is the most common inclined tendon to rupture. About 1 out of 5000 people may have Achilles tendon tear. It is common in sportsmen and athletes.

It occurs mostly in men around age 30 onwards. Abusers of steroids and fluoroquinolone antibiotics are at risks of an Achilles tendon rupture. After diagnosis treatment can be normal resting of the leg and pain relievers or surgery if the tear is extensive.