The Achilles tendon tear

In Germany, around 16,000 Achilles tendons tear, especially when exposed to sport.

definition

In the Achilles tendon (= tendo calcaneus (Achilles)) it is supposed to be strongest tendon in the human body. She sets on Calcaneal tuberosity (= Heel bone) and unites as the end tendon of the Triceps surae muscle (Calf muscle) the end tendons of the three calf muscles.

In case of a Achilles tendon rupture, which arises from previous degenerative damage, is a complete severing of the tendon, mostly as a result of direct or indirect Violence.

You might also be interested in this topic: Achilles tendonitis.

Development of an Achilles tendon tear

Besides the Wear and tear factorsresulting in poor blood flow to the tendon tissue with increasing age well-founded and the purely mechanical explanations for the occurrence of an Achilles tendon rupture there is still biological aspectswhich should be briefly outlined at this point.

Are at risk with regard to this biological aspects especially patients who

• certain medications, such as Cortisone or cytotoxic drugs take in.
  Also Antibiotics from the group of Gyrase inhibitors (Fluoroquinolones) such as ciprofloxacin (Ciprobay) or ofloxacin (Tarivid) are said to increase the risk. They are used for inflammation of the bladder (cystitis), but also for diseases of the nasopharynx.
• under diabetes (= Diabetes) suffer.
• under chronic Connective tissue diseases (rheumatism, gout, Autoimmune diseases).
• under general circulatory disorders, or suffering from chronic connective tissue diseases.
• under certain Infectious diseases Suffer.

Especially when the Achilles tendon tears both sides occur, one can assume that the cause is biological.

Also at good physical condition Achilles tendon rupture can occur. This is especially the case when the tendon fibers are in the During the warm-up phase not warmed up enough, or if it was the result of a low pH to a so-called Lactic acid fatigue comes. In both cases the Achilles tendon is mechanically overstrained and tearing is encouraged.

Appointment with an expert in Achilles tendonitis?

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Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
But now enough is indicated ;-)

Athletes (joggers, soccer players, etc.) are particularly often affected by the Achilles tendonitis disease. In many cases, the cause of the Achilles tendonitis cannot be identified at first. Therefore, the treatment requires a lot of experience. I focus on Achilles tendonitis.

The aim of every treatment is treatment without surgery with a complete recovery of performance.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You can find me in:

• Lumedis - your orthopedic surgeon
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  60311 Frankfurt am Main

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Further information about myself can be found at Dr. Nicolas Gumpert

causes

A rupture of the Achilles tendon occurs mostly spontaneous without the affected person having previously felt pain or other symptoms. In almost 90% of the cases is it a Rupture, which under heavy athletic stress of the tendon occurs. Hence, most of the sufferers are too young, sporty, active men. Still, mostly passed previously minor injuries (Microcracks) of the tendon, which affects its resilience during the subsequent sporting activity have decreased. In addition, the tendon can be damaged by injuries, for example by a Cut in the heel area. If this injury is very deep, it can lead to a complete severing the tendon come.
Some medicines also have Influence on the strength of the tendons in the body. Taking such drugs can therefore lead to an increased susceptibility to all types of tendon ruptures. Medicines that can promote tendon rupture are e.g. certain Antibiotics (Gyrase inhibitors), Corticosteroids, and immunosuppressants. Although the Achilles tendon withstands very strong mechanical loads, it can Age-related or illness-related wear processes subject.
At athletically inactive people the Achilles tendon is also less resilient because it not used to stress is and therefore at sudden stress gives way faster. The signs of wear and tear also lead to decreased tendon elasticity. In addition, the connective tissue fibers that make up the tendon are partially damaged in this case, so that the holding structure the tendon is no longer intact. All of these factors can also promote a rupture of the Achilles tendon.

Other causes of a torn Achilles tendon

The Achilles tendon as such it is mechanically very resilient. One assumes a maximum load capacity of up to 400 CP out. The cause of one Achilles tendon tear is mostly favored by wear and tear processes, which can be intensified by a possibly poor training condition. With such causes, the entire muscular and tendon apparatus is significantly less elastic, making the Achilles tendon torn more likely. As a result of maximum load (unexpectedly high force load), for example during Start to sprint, at the Jump or. Come up after a jump, while skiing or Play soccer, can a Achilles tendon rupture occur. As a rule, the Achilles tendon tear is accompanied by a loud bang, the acoustic appearance of which can be compared to a whip striking. Usually the Achilles tendon is then completely torn. The Achilles tendon usually tears in the area of ​​the narrowest point. You can feel this point yourself: starting from the uppermost area of ​​the Heel bone (Trailing edge) you go up about 5cm.

After a crack is one Plantar flexion (= active bending of the ankle joint, e.g. tiptoe) of the foot is no longer possible due to the lack of connection between the calf and the posterior edge of the heel bone, the patient can no longer walk normally.

Symptoms

As already explained above, the Achilles tendon ruptures with an audible bang (Lash of the whip). In addition, the patient suffers from sharp pain and is due to the calf compression to one active plantar flexion no longer able. It is typical that the patient is no longer able to stand on one leg on the diseased leg.

An Achilles tendon tear is visible from the outside through a Swelling on the back of the ankle, if necessary, will also be a bruise visible. The doctor can also do a clear dent feel.

Achilles tendon pain

A Achilles tendon tear is mostly noticed by the person concerned because of the pain that starts immediately further burden of the affected limb immediately impossible do.

The Pain intensity depends on the extent of damage to the tendon complete or incomplete Tearing and can already be under Resting conditions be very intense. The injured person feels as if he has been badly kicked in the heel. The pain is intensified, its quality as suddenly shooting in and stabbing described by stepping on and trying to stand on the ball of the toe. The Walking ability is strong limited.

In addition to the correct implementation of the treatment measures by the treating doctor, strict adherence to the Sports ban and the doctor's orders given by the patient, as pain persists even after successful treatment chronify and permanently Limitations of resilience being able to lead (Achillodynia).

diagnosis

A Achilles tendon rupture can be diagnosed in different ways. At complete severing of the tendon a gap above the heel can often be felt. In addition, a fresh Achilles tendon rupture shows severe and painful swelling of the tissues, as well as reddening or blue discoloration of the heel region. The patient can also no longer on tiptoe because the tear in the Achilles tendon has severed the connection between the calf muscles and the heel bone. If the patient lies on his stomach on a couch and you squeeze his calf muscles, the Usually bend the foot towards the sole of the foot (Plantar flexion). In the case of an Achilles tendon tear, this no longer happens for the reasons mentioned. This phenomenon is called also positive Thompson test.
The machine diagnostics the Achilles tendon rupture is mainly based on sonography (Ultrasound examination). The attending physician can use the ultrasound device to display the affected region directly on the screen Extent of the crack appraise. Then the Choice of therapy method. If the ends of the Achilles tendon are only slightly apart, the patient can mostly through conservative therapy to be helped. However, if the distance between the ends is large, only surgery can often help. In addition to the ultrasound, a MRI of the Achilles tendon Contribute to the diagnosis of a ruptured Achilles tendon. The MRI is used when the ultrasound is not informative enough or atypical complaints are indicated without a clear cause. The MRI can already healed ruptures, incomplete cracks, and other changes better recognize the tendon.

Diagnosis of an Achilles tendon tear

As soon as the first complaints of the Achilles tendon tear have waned, the patient will find that he is no longer able to walk normally. One speaks of functional failures which, among other things, are also noticeable in the fact that the patient is usually not able to (A leg-) Perform toe stand.

Clinical examination

In the first hours after the Achilles tendon tear the attending physician can feel a dent a few centimeters above the actual Achilles tendon insertion. However, this is only possible in the first few hours after the accident, later a hematoma forms there due to the bleeding, which would make the diagnosis of the Achilles tendon torn much more difficult.

Thompson test

Plantar flexion is usually eliminated after the Achilles tendon tear. In patients with deep flexor muscles, residual flexion can be retained, but this usually differs significantly from the normal state. In order to better assess the plantar flexion (bending of the foot), the so-called Thompson test can be carried out to diagnose the Achilles tendon tear. To do this, the attending physician presses on the calf area. This compression (see picture) in the event of a torn Achilles tendon, plantar flexion becomes impossible.
Typical of an Achilles tendon rupture is also the failure of the Achilles tendon reflex, the testing of which is usually quite painful for the patient. In about 70% of all cases, an Achilles tendon tear can also be detected and precisely localized using sonography.

In addition, an x-ray can be taken to rule out a bony tear in the Achilles tendon. This exclusion can have decisive effects on the therapeutic care (see therapy of the Achilles tendon tear).

course

Of the Course of the Achilles tendon tear is mainly influenced by the chosen treatment method. Operative therapy methods can use more often Wound healing disorders and infections in the operating theater. With intensive therapy in connection with physiotherapy training can be the original agility and tendon performance can be regained in most cases. It is also crucial whether the Tendon completely torn or just torn is. Is she completely torn can also be distinguished whether they including a piece of bone demolished or not. Since the therapy depends on the type of Achilles tendon damage, this factor is for Course and prognosis of the disease decisive. Especially with high-performance athletes, the full efficiency is often no longer achieved as the tendon cannot return 100% to its original state. There remains at least one Residual scar tissuewhich can already reduce the level of performance in high-performance sport. It is important that the Achilles tendon tear detected early and treated accordingly becomes. Otherwise it can too permanent functional restriction with decrease in Calf muscles come. Same goes for failed operations or inappropriate other therapeutic measures.

Conservative therapy

Conservative therapy means the Achilles tendon rupture not treated surgically will, but other methods of healing can be used. Conservative therapeutic measures will be especially with only torn tendons, as well as used in elderly patients who have the tendon then load less become.

These measures primarily include one temporary immobilization of the affected ankle in a special cast or shoe. These special shoes are equipped with a heel liftthat promotes healing of the torn tendon. In addition, the patient can use the unyielding special shoe Put weight on the foot again in good time. After about 3 weeks are usually additional physiotherapeutic measures initiated to promote and restore the mobility of the Achilles tendon, including the lower leg and foot. This therapy should be continued until the original functionality is restored.

Read more on this topic at: Achilles tendon rupture conservative therapy

Operation of an Achilles tendon tear

Especially in young people who want to exercise, and if the ends of the torn Achilles tendon are far apart, a operative therapy be considered. The operation can either under local or general anesthesia be performed. The torn tendon will exposed during surgery and the free ends will be fixed together again by seams. Is the tendon including a piece of the calcaneus torn off, the torn piece of bone is screwed back onto the heel bone. So the tendon is reattached at the same time.

At severe signs of wear and tear and porosity the tendon may need a Tendon surgery to use. For this purpose, a piece of tendon is removed from the patient elsewhere, which is then used by the Bridging the damage serves the Achilles tendon. The tendon of the Plantaris longus muscle used, which fulfills no important function and is designed for most patients.

The advantage of surgical therapy compared to conservative measures is that the Achilles tendon is more stable afterwards and a renewed rupture much less frequently occurs. After surgical therapy, the foot must immobilized for a few weeks become. Then you can physiotherapeutic measures to be initiated to regain functionality.

Further information is available under our topic: Achilles tendon rupture surgery

Refraining from therapy

Will the Achilles tendon rupture not treated, this can be too severe loss of functionality to lead. The ends of the tendon grow within a few months pitted together again, but this leads to a significant elongation of the tendon through the scar tissue. This requires a Functional restriction of the calf musclebecause he is through the elongated tendon do not develop optimal strength can. Affected patients suffer from weakness in the Ankle. Even through intensive training measures, full functionality can no longer be restored in this case. In the event of unsuccessful therapeutic measures, a comparable symptoms to adjust. Therefore, an experienced doctor should be used Therapy of the Achilles tendon rupture to be visited.

Healing time

The Time to heal an Achilles tendon rupture depends on the severity of the crack. Is the tendon completely torn, the duration of therapy is usually at least 6-8 weeks. The load on the tendon should be increased again slowly and only after about 3 months correspond to the starting level again. Heavy loads, such as in high-performance sport, should only after about 6 months run again.

Immediate action

After the initial severe stabbing pain, the patient is almost pain-free after a short time. The swelling that was mentioned in the context of the symptoms is not always present. Still must in any case a doctor should be consulted as soon as possible. This is of elementary importance for the correct diagnosis and subsequent therapy (see: diagnosis).

After an Achilles tendon rupture, only First aid measures be carried out based on Cooling of the heel region and Avoidance of occurrence to the injured leg, supporting the patient while walking (by supporting the patient, walking aids (crutches), possibly also by a transport couch).

prophylaxis

Prophylactic can only be mentioned here that regular sporting activities has a positive effect on the elasticity of the entire muscle and tendon apparatus.

At this point it could be Avoid abrupt and heavy loads are listed. Avoiding special "risk sports" (Playing squash) could be named.

Active athletes should go for one proper warm-up phase before exercising. Also stretching - especially after sporting activity - are used for prophylaxis.

forecast

A ruptured Achilles tendon is prognostic to be judged as good. In the case of ideal therapy and appropriate rehabilitation measures, under certain circumstances even the level of performance before the accident can be achieved again.

However, an Achilles tendon tear often means for Top athletes, especially for those who are on Jumping and / or running sports have qualified, the end of the career.

Regarding the form of therapy it should be said that after a operative therapy the prognosis is statistically better than after conservative therapy. While it is at about 4% after surgical therapy If cracks appear again, the rate of conservative therapy is in about 15%.

However, arise Post-operative swelling that often lasts longer. Patients also report sensory disorders in the heel and ankle area.

Historically on the term Achilles

The name of the Achilles tendon comes from the Heroes of ancient Greece Achilles back. He was the son of the immortal sea goddess Thetis and the mortal Peleus. To make her son immortal too, his mother dipped him into the water of the underworld river Styx as a child. By contact with the river water it was Achilles invulnerable and later one of the greatest heroes of Troy. The the only vulnerable part of the body was the heel. His mother had held him there when he was immersed in the river. According to legend, Achilles was killed by an arrow from Paris in his heel.

Summary

At the Achilles tendon rupture (Achilles tendon rupture) it is usually one that occurs suddenly Severing the Achilles tendon. The Achilles tendon rupture occurs only rarely prior noticecaused by Achilles tendon pain or irritation, for example. As a result, they are above average often physically active people affected by an Achilles tendon tear. There is an increase in active men between the ages of 30 and 50.

The tear of the Achilles tendon is usually not to be ignored. Patients speak of a loud bang or one Lash, mostly associated with sharp pain. Since the Achilles tendon is indispensable for normal human gait, it must be ensured that the patient is treated professionally as soon as possible.

In principle, a distinction is made between with regard to therapeutic measures operative therapy and conservative therapyBoth forms of therapy are justified. Nevertheless, it can be said that, in principle, younger patients benefit more from surgical therapy because the Load probability (Sport and work) is significantly increased in younger patients. In older patients, on the other hand, conservative therapy for Achilles tendon ruptures predominates. Studies have also shown that Anglo-American countries are more inclined to use conservative therapeutic measures.

As part of the operative therapy a distinction is made different types of surgery, which will be discussed in more detail in the context of the therapy (see above). Which measure is taken depends, among other things, on the Age of rupture, or from the Manner of avulsion.

In both forms of therapy, a Duration of about 12 to 16 weeks be estimated. The duration of the Immobilization lies by about 6 weeks. The immobilization takes place in particular in the first 4 weeks in equinus position, whereby the degree of equinus position varies. As a rule, the equinus foot position is 30 to 40 ° in the first two weeks and is then reduced to 10 to 20 ° in the 3rd to 4th week. At the end of the immobilization the Lower leg walking cast then made in a plantigran (= 0 °) foot position.
The stress options take in this three-stage immobilization successively to. This should be discussed in detail in the context of the therapy (see below).

In particular after intensive rehabilitation measures one can assume an almost complete recovery of the usual performance.

Across Germany, about 16,000 Achilles tendon tears and - tears.