Probably everyone has heard the ancient Greek myth about the invincible hero Achilles, whom his mother, in infancy, dipped into a special source of immortality, holding him by the heel. Ancient anatomists and healers were very fond of all sorts of poetic comparisons, so they called the most powerful tendon of the human body Achilles. It is about Achilles tendon rupture - one of the most common problems in traumatology - that we will talk today.
The Achilles or heel tendon is the most powerful and strong tendon that connects the muscles of the back of the leg with the heel tubercle. Its middle part can be felt in a small depression at the junction of the calf and the heel. In the experiment, a bundle of connective tissue fibers of the heel tendon withstood more than 300 kg to break, but in life this tendon experiences enormous loads and is damaged quite often.
The main task of all tendons in the human body is to transmit muscle force to certain structures. Simply put, they play the role of levers, participating in flexion, extension and rotation of body segments at the joints. The Achilles tendon is responsible for flexion and rotation of the foot and leg. We can safely say that it is one of the main structures responsible for human upright posture, providing foot stability and shock absorption.
Numerous studies have revealed the dependence of the frequency of injuries on the type of human activity. The frequency of ruptures is definitely higher in those patients in whom it was initially subjected to various excessive loads.
These categories include:
We provide a detailed classification of injuries indicating the reasons that caused this or that injury.
With an incomplete rupture or tear, partial damage to the tendon occurs; with a complete rupture, its structure is completely damaged. A separate point is taken to separate the tendon from the heel tubercle.
Depending on the nature of the injury, there are:
Depending on the mechanism and action of the traumatic factor, the following are distinguished:
The symptoms of an Achilles injury will directly depend on the extent of the tear and the type of injury sustained. Let's list the main features:
Before delivering a patient to a medical facility, you need to be able to provide minimal first aid. I would immediately like to draw the attention of readers that any amateur activity is completely unacceptable. It is only important to leave the patient in a stable condition until doctors arrive. The following recommendations must be strictly adhered to:
This is all you can do before the patient reaches the hands of medical workers, who will begin to provide the victim with professional assistance.
Treatment options will depend on the nature of the injury.
In case of incomplete rupture or sprain of the Achilles without compromising the integrity of the skin, treatment is most often conservative. The patient is given special plaster splints or orthopedic “boots” - orthoses that create the most comfortable position for the damaged tendon.
Unfortunately, complete tendon ruptures require surgery. The essence of the surgical intervention is to stitch the ends of the torn tendon using various materials and suture techniques.
After surgical treatment, the damaged foot is plastered in a special boot and a fairly long rehabilitation period begins, which takes up to 6-8 weeks.
Rehabilitation after an Achilles tendon rupture is a very important period in restoring limb function. As we have already said, this period of time begins immediately after the operation and takes about 2 months.
A prerequisite for proper recovery after injury is the wearing of special orthopedic boots - orthoses. These devices hold the foot in a forced position, relieving stress on the Achilles tendon and speeding up its healing process. It is mandatory for such boots to have a small heel - 2.5-3 cm. After about 6 weeks, the orthosis is changed to comfortable orthopedic shoes with an anatomical heel.
Physiotherapeutic treatment is aimed at improving blood flow in the damaged tendon, eliminating swelling and reducing pain. The most effective thermal procedures are: UHF, paraffin therapy, ozokerite therapy. Magnetic therapy is also used to improve blood flow. Electrophoresis with novocaine is effective in reducing pain. In order to restore the tone of the calf muscle, pulsed currents - electrical stimulation - are very useful.
Physical therapy is required during the rehabilitation period. This is necessary for a soft and gradual start of loading on the injured leg. The swimming pool and massage are also very effective. You can gradually return to full-fledged sports activities no earlier than 6 months after recovery.
The Achilles tendon (Achilles ligament) is the strongest in the human body. It is located on the back of the lower leg and connects the muscles with the heel bone. Thanks to this connection, a person bends the foot at the ankle joint. So, we stand on our tiptoes and push off with our feet when running and jumping. The Achilles tendon plays a key role in a person’s ability to move freely, so damage to it can lead to serious consequences, including disability.
Injury to the Achilles ligament occurs as a result of strong external influences or serious diseases that disrupt the structure of the fibers. Injuries are divided into several types.
Its main condition is severe overexertion or a blow to a stretched ligament. This happens most often in professional sports or in car accidents. Normal mechanical damage is preceded by microtraumas that disrupt the tissue structure. Rupture of a healthy Achilles occurs very rarely with a targeted strong external impact - injuries at work, car accidents, falls from a height.
Acute inflammation of the Achilles tendon - achilles (or achillotendinitis) is rare. Usually this is a gradually developing process in which neighboring anatomical formations are involved (the synovial bursa of the ligament itself - Achilles bursitis, the tissue surrounding the tendon - peritendinitis, damage to the place of attachment of the ligament to the heel bone - enthesopathy). Chronic inflammation is complicated not only by tendon tears, but also by the formation of a heel spur, a lump on the tendon, or calcification. Predisposing causes of Achilles tendinitis are:
Long-term inflammation leads to thinning of the connective tissue fibers, a decrease in its elasticity, which can result in injury.
The degenerative process is usually a consequence of chronic inflammation or constant microtrauma to the ligament, which is observed in professional athletes. Degeneration of connective tissue also occurs when there is insufficient blood circulation in this area in people leading a sedentary lifestyle. Violation of the tendon structure is caused by age, certain medications (glucocorticosteroids, antibacterial drugs from the fluoroquinolone group), especially when used uncontrolled, poor environment, bad habits and many other factors. Sometimes a tendon rupture occurs spontaneously for no apparent reason. This is the result of a hereditary disorder in the structure of collagen fibers that form the basis of the ligamentous apparatus.
Depending on the type of injury, the following types of Achilles injury are distinguished:
According to the degree of damage, ruptures can be complete or partial, and according to the time of occurrence - fresh or old.
Causes of complete and incomplete rupture of the Achilles tendon
Regardless of the cause, Achilles tendon injury has common characteristics:
Any type of injury to the Achilles tendon leads to gait disturbance, the person limps or is unable to step on the injured leg.
Any diagnosis begins with a detailed questioning of the patient about the circumstances of the injury. Sometimes this alone is enough to make you think about an Achilles injury. Upon palpation, the doctor detects a characteristic failure of the tissue at the site of the rupture. But Achilles tendon injuries are insidious and often lead to diagnostic errors. Let's consider possible situations when doctors have difficulty establishing the correct diagnosis:
If the patient has developed flexor muscles, the foot will flex even if the Achilles tendon is completely torn.
Then the doctor, at best, will suspect a partial rupture of the ligament, which is treated conservatively.
In order to avoid these mistakes, there is an algorithm for diagnosing an Achilles tendon rupture by performing several tests.
An Achilles tendon rupture is a common soft tissue injury of the lower leg at the junction of the heads of the triceps muscle and the heel bone. Such damage most often occurs in people 30-50 years old who lead an active lifestyle or play sports. This tendon is the most powerful of all those found in the human body and its rupture in almost all cases is complete.
In this article you will receive information about the causes, types, symptoms, methods of diagnosis and treatment of Achilles tendon ruptures. This information will help you identify damage in time and ask the doctor the necessary questions during the treatment process.
The Achilles tendon gets its name from the mythical warrior hero Achilles, described by Homer in the Iliad. According to legend, the hero's mother Tethys, who heard a fortune teller's predictions about the death of her son in a future battle, made him invulnerable by dipping the child into the waters of the Styx. At the same time, she held him by the heel, and this was the only place that was not touched by the magical waters of one of the five rivers of the underworld.
During the Trojan War, Achilles killed Prince Hector, and his brother Paris took revenge on him by shooting a poisonous arrow from his bow. It hit the hero’s heel and since then the Achilles heel has been called the weak spot.
The Achilles (or heel) tendon is located on the back of the lower leg. It is formed at the junction of the external and internal heads of the triceps muscle with the deep head of the soleus muscle. Next, the tendon moves down, narrows and attaches to the tubercle of the heel bone. The tendon is located in a channel that contains fluid (lubricant) that reduces friction during movement.
The function of the Achilles tendon is to flex the ankle joint. Thanks to it, a person can jump, run, walk on steps, rise on his toes, etc. The right heel tendon is more developed, because for most people, it is the right leg that experiences greater load and is the leading one. This is why damage to the left Achilles tendon occurs more often. Typically, such injuries are caused by a fall after an unsuccessful jump.
Damage to the Achilles tendon can be caused by the following factors:
The heel tendon is most vulnerable in people 30-50 years old. This is explained by the fact that by this age degenerative changes occur in its tissues, reducing its strength. A person of this age still considers himself healthy and prepared for physical activity and often overestimates his capabilities.
Depending on the nature of the damage, the following types of Achilles tendon rupture are distinguished:
The main symptom of a heel tendon rupture is sharp and intense pain that occurs at the time of injury. Patients sometimes compare it to the feeling of a cut or blow. At the moment of rupture, a sound in the form of a cracking or crunching may be felt.
With a complete rupture of the tendon, a person cannot bend the ankle joint, and with a partial rupture, movements become weakened. Any attempts to move cause sharp pain. The patient's gait is significantly impaired, he limps severely, and in some cases, due to intense pain, he cannot step on the injured leg.
Swelling appears at the site of injury, and when you feel the place, which is located 4-5 cm above the attachment of the tendon to the heel bone, a “failure” is detected. Later, the swelling becomes more widespread and hemorrhage appears in the same place. Over the course of a few days, the bruise may increase in size and extend down to the fingertips.
If an Achilles tendon rupture is suspected, a person should take pain medication and immobilize the limb before transporting to the hospital. A ladder rail can be used for this. When applying it, the leg should be slightly bent at the knee joint and maximally at the ankle. The splint is applied from the upper third of the thigh to the fingers. After this, cold should be applied to the site of injury to reduce hemorrhage and swelling.
If you suspect a heel tendon rupture, you should contact a traumatologist. The doctor will examine the patient’s complaints and clarify the circumstances that led to the injury.
The following tests are performed to detect a heel tendon rupture:
All tests to detect a heel tendon rupture may not be performed. Two positive test results are sufficient to confirm the diagnosis.
If necessary, in complex cases, to clarify the diagnosis and determine the degree of tendon damage, the following may be prescribed:
Conservative and surgical methods can be used to treat heel tendon ruptures.
The conservative method is aimed at immobilizing the leg with an extended toe using a splint for 1.5-2 months. This method will allow you to bring the ends of the tendon closer and ensure their fusion. The method of limb immobilization for Achilles tendon ruptures is determined depending on the severity of the clinical case.
A correctly made and applied splint made of ordinary plaster sufficiently immobilizes the limb, but wearing it is associated with a number of disadvantages:
For the convenience of the patient, immobilization can be performed not with a plaster splint, but with the help of braces or orthoses. Their main advantage is that they allow you to adjust the angle of the immobilized foot and facilitate further rehabilitation.
Immobilization of the injured leg can be done using plastic casts made from polymers. They are much more convenient for the patient, because they are lighter than regular plaster and are not exposed to water.
Modern surgical techniques allow for functional immobilization, in which the patient’s ankle is not completely immobilized. It is performed using special orthoses or special splints made of plaster or polymer materials. To such devices is added a heel on which the patient rests his foot.
When a tendon ruptures, the integrity of the blood vessels is disrupted and hemorrhage forms at the site of injury. The resulting hematoma prevents the complete approximation of the ends of the damaged tendon. Subsequently, it fuses with elongation and becomes less strong and strong. After treatment is completed, the risk of future rupture increases threefold or more, and the strength of movement in the joint becomes lower.
In some cases, at the time of rupture, degenerative changes are already present in the tendon fibers. It becomes disintegrated and grows worse. Sometimes conservative treatment cannot ensure its recovery, and a few weeks after immobilization it is necessary to perform surgical intervention to stitch it together.
Considering all the shortcomings of conservative methods, we can conclude that they can only be used in cases where treatment began within the first few hours after the injury, and the patient does not engage in professional sports and does not lead a sufficiently active lifestyle. Typically, such methods of therapy are recommended for older people, and in other cases, it is more justified to perform a surgical operation that allows you to accurately compare and stitch the fibers of the damaged tendon. This method provides more reliable and faster results.
Surgery for calcaneal tendon ruptures should be performed as soon as possible after the injury. This is explained by the fact that over time the muscles become shorter and it is more difficult to accurately compare the torn ends, and after 18-20 days it is no longer possible to perform such an intervention.
Spinal anesthesia, local anesthesia, or intravenous anesthesia may be used to relieve pain from such surgeries. The choice of technique depends on the patient’s health condition.
In a classic operation, an 8-10 cm long skin incision is made on the back surface of the leg. The surgeon accesses the tendon, “cleans” its edges and stitches it with a tendon suture. There are many methods for making such seams, and the most common is the Krackow seam. It is applied to both ends of the damaged tendon, and the edges of the threads are tied. After completing the suture, the surgeon sutured the wound in layers.
The classic Achilles tendon suturing operation has a number of disadvantages:
To exclude them, operations for percutaneous suturing of the tendon can be performed: according to Trachuk, Ma, Griffith, etc. During such interventions, no skin incision is made and the tendon is sutured through punctures. Percutaneous stitching also has a number of disadvantages:
Modern surgical technologies allow us to completely eliminate such possible complications of interventions for suturing the Achilles tendon:
3 weeks after the Achilles tendon rupture, its suturing cannot be carried out using the above methods. To restore it in such cases, tendon plastic surgery can be performed. To do this, only open surgery with a long incision can be performed. It is performed using different methods. Tendon sections taken from its upper end, other tendons or synthetic materials can be used as a graft.
In case of repeated ruptures of the Achilles tendon, surgical intervention can only be performed using an open technique.
After completion of the operation, the patient's limb is immobilized, as with conservative treatment, and in the first weeks he needs to walk on crutches. It is most preferable to immobilize using an orthosis, since while wearing it, the angle of flexion of the foot may change. Patients remain with their toes extended for about a month, and then the angle gradually changes and the patient is allowed to walk independently. In most cases, immobilization is canceled after 1.5 months, but in some cases the period of wearing the brace is extended.
The rehabilitation program, i.e. development of the joint, begins during the immobilization of the limb, and this approach improves treatment results. To restore the patient, therapeutic exercises and physiotherapy are recommended.
Achilles tendon rupture is a common injury that requires prompt medical attention and early treatment. It can be performed using conservative or surgical techniques. The choice of treatment method is individual and determined by the severity and duration of the injury, the age of the patient and the equipment of the medical institution.
If you suspect an Achilles tendon rupture, you should consult a traumatologist. After interviewing and examining the patient, the doctor may prescribe other instrumental diagnostic methods (X-ray, MRI, ultrasound).
Orthopedic traumatologist P. G. Skakun talks about the rupture of the Achilles tendon:
Is rehabilitation necessary for an Achilles rupture? That’s what we’ll talk about today. The Achilles or calcaneal tendon is considered the largest in the human structure and plays a vital role in the functioning of the human body. An Achilles rupture impairs a person's ability to run.
If you suspect a rupture, you should immediately consult a doctor to accurately diagnose the damage. Under no circumstances should you delay it, since a rupture is considered a very serious injury to the musculoskeletal system.
A heel tendon rupture is a fairly common injury, most often occurring in people between the ages of 30 and 50 who engage in active sports. But even a person far from sports is not immune from such damage.
The most common causes of subcutaneous rupture are the following:
In addition to subcutaneous damage, an open rupture is quite possible. Occurs when a wound is applied to the tendon area with a knife or other sharp object.
Recovery from a tear repair procedure involves performing a variety of exercises to strengthen the leg muscles and damaged tendon.
In general, the entire period of rehabilitation for an Achilles rupture can be divided into three stages, each of which has its own characteristics.
Begins 1-2 days after surgery. It consists of gradually placing a load on the operated limb and performing simple movements. For example, active rotation of the toes of the sore leg, exercises on the knee and hip joints.
You can recover thanks to exercise therapy. If prescribed by a doctor, massage of the operated limb is possible. Performing all the exercises prescribed by your doctor during the initial stage of recovery will help avoid muscle atrophy and joint problems in the injured leg in the future.
It begins with the procedure for removing the cast after 6 weeks from the date of surgery. Exercises at this stage ensure restoration of range of motion of the ankle joint and normalization of gait.
Passive exercises are practically excluded here. The load on the operated limb increases more and more.
In addition, walking is performed with the foot rolling and backwards. Light loads on strength training equipment are prescribed.
In addition to exercises, massage is often prescribed at this stage to eliminate swelling after the cast is removed.
Aimed at the final and complete restoration of range of motion.
The exercises prescribed earlier are also provided, but with increasing intensity. In addition, massage sessions for the entire injured limb are added to physical therapy.
The final recovery time for a patient after surgery can be called 2.5-3 months. You can begin physical activity after six months from the date of surgery. Absolute recovery after a heel tendon rupture is possible only after timely consultation with a doctor and professional elimination of the consequences of the injury.
If the diagnosis is delayed and further stress is placed on the damaged area when walking, the ends of the Achilles tendon will slowly move away from each other.
In this regard, carrying out an operation with subsequent recovery measures can be problematic.
Damage to the Achilles does not occur unnoticed and has quite pronounced symptoms.
First of all, there is a feeling of sharp pain, as if the tendon area was hit with a stick or other object.
In addition to the main feature, others can be identified:
When these symptoms appear, the first thing to do is apply something cold to the injury site and elevate the leg using pillows. Then immediately call a doctor. If the pain is too strong, you can take a pain reliever.
Until the doctor arrives, it is better not to touch the injured leg at all. Only professional medical care and diagnostics can determine the nature of the injury and indicate further actions. No forum or reviews from former patients will help you.
There are several options for treating and repairing a torn heel tendon.
The choice of method depends on the amount of time that has passed since the injury and its very nature.
There are several ways to treat an Achilles rupture.
It involves repairing a rupture without surgery.
The use of such treatment is possible only within a few hours after injury.
The idea is to fix the lower leg by applying a plaster cast with the toe of the foot extended, which allows the ends of the tendon to be brought together and ensure their fusion.
The method has the following disadvantages:
In addition, the use of this method does not always achieve effective results, since sometimes the tendon does not heal at all.
Involves direct suturing of torn tendon ends.
The operation is possible in two ways:
It should be remembered that such methods of eliminating an Achilles tendon rupture are possible only with fresh injuries. If more than 20 days have passed since the injury, then the operation is performed only in an open manner with a long incision and plastic surgery of the damaged tendon.
The Achilles tendon (AT) is the one that suffers the most from stress both among athletes (athletes, volleyball players, basketball players, etc.) and among ordinary people, especially women whose ankle is constantly in a tense, extended position (ballerinas, lovers of shoes with high heel). Also suffering are people who are accustomed to sitting all day long, but sometimes burden the poor ankle with unusual tests - walking for many hours, digging up a garden and other feats. The result can be severe pain in the heel and swelling at the back of the ankle - often caused by Achilles tendinitis.
In the Achilles tendon, inflammatory and degenerative processes can occur simultaneously, accompanied by coarsening of the tendon tissue and calcification. In this regard, several types of tendonitis are distinguished here, which are often combined into one group - tenopathy.
AC tendinitis is characterized by a chronic course. If you do not start treatment immediately at the moment of exacerbation, then it will be extremely difficult to cope with the pathology later. This is explained by the fact that tendon regeneration at the site of micro-tears, although it occurs quickly, leads to very unstable healing.
In order for the tendon to become stronger, it needs to be immobilized in almost the same way as with a regular injury, up to and including walking on crutches. But most people treat this disease lightly, like a simple sprain. Meanwhile, this is very serious: the tendon, which has healed overnight, is injured again on the second day, and this happens endlessly.
In places of constant micro-tears, rough fibrous scars grow. The tendon thickens, calcifies, and eventually a ridge (Haglund's deformity) or heel spur appears on the back of the heel.
A tendon that has lost collagen and elastin is at risk of rupture over time.
For diagnosis, a physical examination by an orthopedic surgeon is important to determine points and areas of tenderness and differentiate tendonitis from tendon rupture:
Verification of the diagnosis is made by radiography, which shows coarsening of the tendon and the appearance of calcifications.
An MRI is required to diagnose inflammation.
They resort to it if success is not achieved by conservative methods within six months.
Returning to previous activities is done carefully, with immediate removal of any stress when tendinitis symptoms return.
To apply the bandage to the foot and wear it, you will need an elastic adhesive plaster and heel pads 0.6 cm thick.
The foot bends at the sole as shown in Fig. 1 until an unpleasant sensation appears.
In Fig. Figure 2 shows the final fastening of the bandage using a softer version of limiting the dorsiflexion of the foot:
K. Heel pads can be placed under both heels of shoes.
To prevent the use of heel pads from causing excessive shortening of the tendon, regular exercises for the muscles of the back of the leg are necessary.
The Achilles tendon is one of the most powerful tendons found in the human body. It can withstand enormous loads when a person moves and performs various actions. It is located at the back of the shin and firmly connects it to the heel bone. Descending towards the calcaneal tubercle, it narrows significantly. This tendon is located in a special channel, which is filled with a specialized fluid that reduces the intensity of friction. The flexion function of the ankle joint is entirely dependent on the Achilles tendon.
Achilles rupture is a fairly common injury, which, according to statistical studies, most often occurs in people involved in a variety of sports or in cases of overly extreme pastime.
There are several types of Achilles injury:
The rupture can also be fresh or old
An Achilles tendon injury can occur due to:
Also, an auxiliary situation that increases the possibility of torn Achilles becomes:
A torn Achilles can be diagnosed using the following symptoms:
Treatment of an Achilles tendon rupture can be carried out either conservatively or surgically. In order to choose the most suitable method, the doctor needs to study all the results of his research:
After the victim’s diagnosis has been fully studied, the doctor determines the type of treatment needed. Also, the method of treatment tactics depends on the age of the patient and his body characteristics. Often, if the victim has no contraindications to the operation, then doctors recommend surgical intervention.
Conservative treatment is used in the mildest situations (incomplete rupture, tendon sprain, etc.). This therapeutic method consists of fixing the injured limb using a plaster cast or a specialized orthosis. The limb is immobilized in a raised heel position. This position allows you to minimize the distance between the torn parts of the tendon.
External therapy is good because it helps protect the victim from an incorrect reaction to anesthesia and minimizes the risk of infection that is possible with open surgery.
Disadvantages of the conservative treatment method:
The surgical intervention consists of making an incision in the soft tissue in the lower region of the leg and through this hole the integrity of the torn tendon is restored. If his condition is quite poor, then during the operation the injured Achilles is strengthened with the help of other ligaments or special artificial materials.
When applying percutaneous sutures, the places of ruptures are firmly juxtaposed with each other. The only drawback of such a closed operation is that the attending physician may incorrectly compare the damaged parts of the tendon due to the fact that he does not have visual access to them.
In order to maximally protect the patient during surgery, the doctor must use special antibacterial drugs and make small tears.
To fully restore the functionality of a limb that has recently been diagnosed with Achilles rupture, the attending physician prescribes the beginning of a rehabilitation period. Its duration depends entirely on the severity of the injury; on average, the full period is six months. The following rehabilitation methods may be prescribed (including after surgery):
Developing exercises should be strictly prescribed by your doctor, based on your diagnosis. Any incorrect actions and manipulations can aggravate the existing problem. Physical activity should be done first in a minimal amount, gradually increasing its complexity, duration and number of repetitions.
Physiotherapy and massage procedures should be carried out by a qualified specialist so as not to lead to complications. The frequency of these procedures is also determined by the victim’s attending physician.
If the doctor's recommendations are not followed, the following complications may occur: