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Overview

The Achilles tendon is the thickest and strongest tendon in the human body. It plays a very important role in most sport activities and is particularly vulnerable to overloading from repetitive running and jumping. The Achilles tendon forms a joint distal tendon for the gastrocnemius and the soleus muscles. These muscles combine to form the triceps surae muscle. Athletes who sustain Achilles tendon ruptures most frequently are those who participate in ball sports that demand rapid changes of direction and quick, reactive jumps (e.g., tennis, squash, badminton, and soccer), in addition to runners and jumpers in track and field. Sometimes a patient with a ruptured tendon has a history of long-term pain localized to the tendon, but more often the rupture occurs without warning. Such ruptures are often caused by degenerative changes in the tendon (tendinosis), usually in the segment of the tendon that has the worst blood supply. This segment extends from 2 to 6 cm proximal to the insertion of the tendon onto the calcaneus.

Causes
There are a number of factors that can increase the risk of an Achilles tendon rupture, which include the following. You?re most likely to rupture your Achilles tendon during sports that involve bursts of jumping, pivoting and running, such as football or tennis. Your Achilles tendon becomes less flexible and less able to absorb repeated stresses, for example of running, as you get older. Small tears can develop in the fibres of the tendon and it may eventually completely tear. There is a very small risk of an Achilles tendon rupture if you have Achilles tendinopathy (also called Achilles tendinitis). This is where your tendon breaks down, which causes pain and stiffness in your Achilles tendon, both when you exercise and afterwards. If you take quinolone antibiotics and corticosteroid medicines, it can increase your risk of an Achilles tendon injury, particularly if you take them together. The exact reasons for this aren't fully understood at present.

Symptoms
Symptoms include a sudden sharp pain in the achilles tendon which is often described as if being physically struck by an object or implement. A loud snapping noise or bang may also be heard at the time. A gap of 4 to 5 cm in the tendon can be felt which may be less obvious later as swelling increases. After a short while the athlete may be able to walk again but without the power to push off with the foot. There will be a significant loss of strength in the injured leg and the patient will be unable to stand on tip toes. There may be considerable swelling around the achilles tendon and a positive result for Thompson's test can help confirm the diagnosis.

Diagnosis
The diagnosis is usually made on the basis of symptoms, the history of the injury and a doctor's examination. The doctor may look at your walking and observe whether you can stand on tiptoe. She/he may test the tendon using a method called Thompson's test (also known as the calf squeeze test). In this test, you will be asked to lie face down on the examination bench and to bend your knee. The doctor will gently squeeze the calf muscles at the back of your leg, and observe how the ankle moves. If the Achilles tendon is OK, the calf squeeze will make the foot point briefly away from the leg (a movement called plantar flexion). This is quite an accurate test for Achilles tendon rupture. If the diagnosis is uncertain, an ultrasound or MRI scan may help. An Achilles tendon rupture is sometimes difficult to diagnose and can be missed on first assessment. It is important for both doctors and patients to be aware of this and to look carefully for an Achilles tendon rupture if it is suspected.

Non Surgical Treatment
Achilles tendon rupture is treated using non surgical method or surgical method. Non surgical treatment involves wearing a cast or special brace which is changed after some period of time to bring the tendon back to its normal length. Along with cast or brace, physical therapy may be recommended to improve the strength and flexibility of leg muscles and Achilles tendon.


Surgical Treatment
Surgery could allow for a quicker healing time. The procedure generally involves making an incision in the back of your lower leg and stitching the torn tendon together. Depending on the condition of the tissue, the repair may be reinforced with other tendons. As with any surgery, the main complication is the risk for infection, however, this risk is reduced by using smaller incisions.

Prevention
The following can significantly reduce the risk of Achilles tendon rupture. Adequate stretching and warming up prior to exercising. If playing a seasonal sport, undertake preparatory exercises to build strength and endurance before the sporting season commences. Maintain a healthy body weight. This will reduce the load on the tendon and muscles. Use footwear appropriate for the sport or exercise being undertaken. Exercise within fitness limits and follow a sensible exercise programme. Increase exercise gradually and avoid unfamiliar strenuous exercise. Gradual ?warm down? after exercising.