Thursday, January 19, 2012

The Achilles Heel of the Achilles Tendon

The Achilles tendon is the large fibrous tissue that connects the heel to the muscles of the lower leg.  Named after Achilles, the ancient Greek hero of the Trojan War who was invulnerable except for one spot on his heel, it is the thickest and strongest tendon in the body, so that it can connect with the most powerful muscle group in the body - the calf muscles (plantaris, gastrocnemius and soleus muscles) to the heel bone (calcaneus).  The tendon is vital to such activities as walking, running and jumping, and it’s the sudden explosive starts in sports such as basketball, tennis and racquetball that does the most damage to a tendon that is weak and thinned with age or under-use. An acute rupture of the Achilles tendon can happen to any level of athlete whether world class or recreational. However, research indicates that typically it is the “weekend warrior” male athlete between ages 30 and 50 with no previous tendon issues and is intermittently active, who suffers from this type of injury. 

Diagnosis of a ruptured Achilles tendon is made in a variety of ways.
  • Typically the patient will say that it felt like they were kicked or shot behind the ankle.
  • Presence of a gap in the tendon. However swelling can disguise the gap in acute ruptures.
  • Conduct a Thompson test. With the patient lying face down and feet hanging off the edge of the examination table, the test is positive if there is no plantar flexion of the foot when the adjacent calf is squeezed. Likewise, the test is negative if the foot moves in a plantar flexion direction signifying that the muscles that the tendon is still attached.
Treatment options for an Achilles tendon rupture include surgical and non-surgical approaches and among the medical profession, opinions are divided as to which is preferred.

A few ways to possible prevent Achilles tendon injuries are:
  • Begin any new physical activity programs slowly over time.
  • Do not use equipment you are not familiar with.
  • Wear appropriate footwear.
  • Don’t be the “weekend warrior.” Exercise regularly.
  • Try to limit the amount of time exercising on hard surfaces, such as concrete.

For more information on sports medicine injuries, please contact SIRC.

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