What Is a Ruptured Achilles Tendon?

The Achilles tendon is the most powerful tendon at the back of the foot and ankle. It can withstand great tension. Apart from individual diseases and special movements, it is difficult to break in daily life. The function of the Achilles tendon is responsible for the plantar flexion of the ankle joint, and plays an important role in the completion of daily activities such as walking. The high-risk group of Achilles tendon rupture is student athletes and actors. In recent years, the extensive development of mass sports and continuous improvement of sports level have increased the incidence of Achilles tendon rupture year by year. Except for a few open Achilles tendon ruptures caused by orthotopic Achilles tendon trauma, most Achilles tendon ruptures are caused by indirect external forces. Some patients with Achilles tendon rupture have Achilles tendon-related chronic disease before Achilles tendon rupture occurs. Achilles tendon rupture is also more common in people who are engaged in heavy physical activity only on leisure or rest days. Achilles tendon rupture occurs in the four seasons in the early spring and early autumn.

Basic Information

English name

rupture of Achilles tendon

Visiting department

orthopedics

Multiple groups

30-50 years old male

Common causes

Direct or indirect violence

Common symptoms

The Achilles tendon is locally swollen, painful, weak, and can't stand on tiptoes

Causes of Achilles Tendon Rupture

Achilles tendon rupture occurs in male patients aged 30-50 years. Its incidence in developed countries is 2 to 10 / 100,000 per year. The incidence is relatively low in developing and less developed regions. The average age of patients with rupture is about 35 years old, and the absolute proportion of male patients is about 4: 1 to 20: 1. There are two types of people with high incidence of Achilles tendon rupture that should be noticed. One is people who are relatively static and willing to participate in high-intensity physical activity intermittently. The other is people who are in low-intensity long-term physical activity all year round. The population is a high-risk group for Achilles tendon rupture. The warm climate is the time when Achilles tendon is high, and the highest incidence is at the node where the climate is not suitable for outdoor sports activities to be suitable for outdoor sports activities. Generally, it is the winter and spring transfer and the summer and autumn transfer.

In addition to the rupture of the Achilles tendon caused by direct violence, the mechanism of Achilles tendon rupture caused by indirect violence is caused when the ankle joint is in a hyperextension and the calf triceps is suddenly exerted. When the ankle joint is stretched at 20 degrees ° 30 °, the radius of the axis from the calcaneal tuberosity to the ankle is large, and the Achilles tendon is in a state of extreme tension. At this time, it is suddenly forced to jump, and the already stressed Achilles tendon needs to bear A force that is several times greater than its own gravity causes the Achilles tendon to rupture.

Other high-risk factors that cause Achilles tendon rupture include the use of hormones, the use of quinolone antibiotics; gout, hyperthyroidism, renal insufficiency, and arteriosclerosis; previous Achilles tendon injuries or lesions; infections and systemic inflammatory diseases; high Blood pressure and obesity.

Clinical manifestations of Achilles tendon rupture

The skin of the open Achilles tendon rupture caused by direct trauma is bleeding and the Achilles tendon tissue is visible in the wound, which is easy to diagnose. In some patients, it is not easy to detect and miss the diagnosis due to the Achilles tendon rupture and retraction. Later, they often seek treatment again because of inability to raise the palate. A triceps pinch test can be performed at the time of injury to diagnose.

The rupture of the Achilles tendon caused by indirect external force occurs when the ankle joint is stretched in the dorsal position for bouncing or pedaling. Patients often report that they have a sticky sensation behind the heels, and then there is weakness in lifting, and they cannot complete the steps of kicking and jumping. It is manifested as difficulty walking and weak propulsion accompanied by limp. Depression appears at the Achilles tendon. The soft tissues gradually swell over the next few hours or days. Heel bruises appearing behind the ankle. The easiest diagnostic test is to determine the continuity of the gastrocnemius-soleus complex by squeezing the posterior calf muscles (Thompson sign). Place the patient's prone feet outside the edge of the bed, and pinch the calf triceps abdomen. The normal lateral ankle immediately flexes when pinching the muscle, and the ankle does not move when pinching the muscle when the Achilles tendon is completely broken.

Achilles tendon rupture diagnosis

Medical history

Acute Achilles tendon rupture has a clear history of injury during exercise. Most patients can clearly review that there is a stick and a bounce behind the ankle when the injury occurs, and the injury often occurs when the ankle joint is extremely extensor.

2. Symptoms and signs

The iliac crest is limited, the back of the Achilles tendon is sunken, and it is accompanied by swelling or subcutaneous bleeding. Heel pain, palpable depression at the Achilles tendon distal to the calf, Thompsontest positive. The calcaneal tubercle moves down.

3. check

The most effective and convenient inspection method is ultrasound, which can determine whether the Achilles tendon is broken and the location of the break. Subsequent MRI can further check the degree of Achilles tendon degeneration. Ordinary X-ray film can be used to determine whether it is accompanied by an acute avulsion fracture of the Achilles tendon attachment site.

Achilles tendon rupture treatment

Patients who have a hamstring dysfunction and dyspepsia with hindfoot pain should go to the hospital as soon as possible to clarify or rule out the diagnosis of Achilles tendon rupture and prevent it from becoming an old Achilles tendon rupture. The choice of surgical or non-surgical treatment according to the specific circumstances of the patient. The success or failure of Achilles tendon rupture surgery lies in accurately grasping the tightness of the suture. This is not easy to achieve with non-surgical treatment. For the average person, the effect of conservative treatment can achieve basically satisfactory results. For athletes and entertainers engaged in complex activities, a small change in Achilles tendon tension can completely lose sports or performance life. Therefore, for people with higher functional requirements, in addition to unconditional surgery or local skin infection is not appropriate for surgery, non-surgical treatment can be taken, other times surgical treatment is better. For the open Achilles tendon rupture, surgery is needed in the shortest possible time to prevent wound infection.

Non-surgical treatment

Knee flexion and plantar flexion can be applied, and knee joint flexion is 45 °. Can promote the two Achilles tendon stumps close to each other to promote the Achilles tendon stump healing, the fixed time is generally 6 to 8 weeks. Initially, the long-leg brace that has passed the knee joint is used to limit the knee joint to the flexed state, while the ankle joint is limited to the plantar flexion state to minimize the Achilles tendon tension. After 4 weeks, the plaster above the knee joint was sawed off and replaced with short leg plaster. Compared with surgical treatment, the non-surgical Achilles tendon rupture rate is higher (1.7% to 10%), but there is no risk of poor incision healing, incision infection, and nerve damage.

2. Surgical treatment

There are various surgical methods, and the choice depends on the specific conditions of the Achilles tendon injury seen during the operation, including various tendon sutures and techniques to increase the strength of the tendon by choosing other adjacent tendon tissues. Active rehabilitation is required after surgery to ensure the effectiveness of the treatment. There are also risks of wound healing, wound infection, nerve damage, and poor outcome.

Achilles tendon rupture prevention

According to the epidemiological characteristics of Achilles tendon rupture, it is known that the main cause of Achilles tendon rupture caused by indirect external force is due to the rapid contraction of the calf triceps in the state of ankle dorsiflexion. No known sport has such technical actions. Therefore, mastering the correct technical movements in the process of exercising is an important means to avoid Achilles tendon rupture. Other known risk factors related to Achilles tendon rupture include local injection of hormone drugs and the use of quinolones should be avoided as much as possible. Fatigue caused by excessive strength and overloaded exercise is also an important factor leading to Achilles tendon rupture. Therefore, for those people who do not participate in sports activities regularly, they should gradually increase their daily activities, spread the concentrated exercise time on the weekends into the week, and prepare for warm-up activities before exercise, and choose a moderate amount of exercise based on their specific conditions when exercising. , Reduce excessive exercise time, etc., are of great significance to prevent the occurrence of Achilles tendon rupture.