Achilles Tendon Rupture Overview - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes the anatomy of Achilles tendon.
The Achilles tendon is the strongest and thickest tendon in the body. It is formed from the soleus and gastrocnemius muscles. The Achilles tendon is located on the posterior surface of the calcaneus distal to the posterior-superior calcaneal tuberosity.
The Achilles tendon allows plantar flexion of the ankle. The Achilles tendon is prone to tear or rupture and most of the ruptures occur above the calcaneal insertion of the tendon. When the tendon ruptures, the patient will feel a “pop” in the back of the heel. It will feel as if the patient has been hit in the back of the heel and there will be pain and difficulty walking. Rupture of the Achilles tendon occurs due to limited blood supply. Tendonitis or rupture of the tendon occurs within the area of poor blood supply known as the watershed zone. When the Achilles tendon ruptures within this area, the result may be similar to pulling rope. The mechanism of injury for rupture of the Achilles is usually from an eccentric load on a dorsiflexed ankle with knee extension. Rupture of the Achilles tendon is referred to as the weekend warrior’s injury. The injury typically occurs form overperforming or overdoing the activity.
Sports-related rupture of the Achilles tendon has seen an increase over the last decade. Rupture of the tendon can be complete or incomplete. Occurs more in men age 30-40. This is the age when changes in the tendons stiffness, tissue type and blood flow occur as well as range of motion.
Physical examination will show a palpable gap, weakness in plantar flexion and atrophy of the muscles in chronic cases. Some cases are missed and the Thompson test should be done when a rupture is suspected. The Thompson test is a gold standard for diagnosis of Achilles rupture. The plantaris muscle may give a different interpretation of the Thompson test if it is intact. When the examiner squeezes the calf muscle, there should be the motion of the foot, which is a sign of an intact Achilles tendon. With a complete tear of the Achilles tendon, there will be no movement of the ankle when performing the Thompson test. The tendon is noticeably intact in the normal ankle compared to the ankle that has a rupture of the Achilles tendon.
Medications that may affect the Achilles tendon:
•Anti-inflammatory
•Steroids
•Cipro
Consider systemic conditions associated with rupture of the tendon:
•Gout
•Hyperthyroidism
•Diabetes
Increased stresses on the tendon
•At rest, tendon will have a wavy configuration
•When doing sports, the strain on the tendon increase.
•If the strian is less than 4% (physiological load) the fibers return to their original configuration.
•Strain between 4-8% overuse injury, microscopic failure
•Strain beyond 8% causes tendon rupture and consideration of surgery.
Treatment usually surgery, however nonoperative methods can be used for early and sedentary patients.

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