Article written by Dr. Bogdan Dariciuc , Orthopedic-Traumatology Specialist
The Achilles tendon is the largest and strongest tendon in the human body, originating in the gastrocnemius and solar muscles (gastro-solar muscle group) and insertion on the calcaneal tuberosity. When contracted, these muscles pull on the Achilles tendon, raising the heel and lowering the anterior region of the plant (plantar flexor of the ankle). Although it has a strong structure, the Achilles tendon is vulnerable to trauma due to its limited blood supply and the high pressure it is subjected to. It usually has a remarkable response to stress: exercise induces an increase in the size of the tendon, and sedentary lifestyle or immobilization causes rapid atrophy.
Achilles tendon rupture is more common in men between the ages of 30-40. Achilles tendon ruptures can also be partial or complete . When the tendon is completely broken, plantar flexion no longer occurs in the ankle joint. Complete ruptures are more common than partial ruptures.
Achilles tendon rupture: risk factors
The risk factors that can lead to the rupture of the Achilles tendon are:
- Achilles endinitis – weakens the tendon;
- chronic conditions (which interrupt blood supply): chronic renal failure, hyperparathyroidism, gout, rheumatoid arthritis, diabetes, infections and metabolic diseases;
- steroid injections _
- ” Weekend warrior „
How does the Achilles tendon rupture?
Forced dorsiflexion can usually occur as a result of a sports accident. The patient reports a direct click / blow on the contracted tendon. In some cases, the rupture may be preceded by tendonitis, which has the effect of weakening the tendon.
What are the symptoms of Achilles tendon rupture?
If the Achilles tendon ruptures, the following may occur:
- pain and functional impotence;
- edema, post-traumatic bruising, depending on when the trauma occurred;
- the foot is maintained in slight plantar flexion and pronation;
- regional muscle atrophy that may be encountered in chronic cases;
- palpation is perceived as disruption of the continuity of the Achilles tendon;
- the Thompson test is positive for a complete rupture when plantar flexion cannot be performed (squeezing the leg with the hand causes plantar flexion if the Achilles tendon is intact);
- inability to stand on tiptoes, increased amplitude of passive dorsiflexion, painful plantar flexion.
Diagnosis of Achilles tendon rupture
The diagnostic methods indicated are:
- radiography – for the diagnosis of possible associated lesions;
- ultrasound – to confirm the diagnosis and differentiate between partial or complete rupture;
- MRI allows a definite diagnosis and is useful in chronic ruptures.
Achilles tendon rupture: treatment methods
Orthopedic treatment is indicated for:
- sedentary patients or those who refuse surgery;
- inoperable patients;
- patients with partial rupture;
and consists of:
- immobilization with plaster cast or orthosis with 20 degrees of plantar flexion initially, later with the correction of the equine;
- anticoagulant treatment during immobilization;
- walking with axillary crutches without support 6 weeks.
Orthopedic treatment has a higher risk of rupture than surgical treatment.
Different surgical techniques can be used for surgical treatment :
1. Open technique with end-to-end suturing of the ends of the Achilles tendon used in acute ruptures up to 6 weeks.
2. Ma and Griffith percutaneous technique
- increased risk of sural nerve damage;
- lower risk of postoperative wound complications / infections.
3. Reconstruction pine VY technique – indicated in chronic ruptures (less than 3 cm);
4. Long toe flexor transfer and reconstruction by VY technique – indicated in chronic ruptures (over 3 cm).
Postoperatively it is recommended:
- immobilization with plaster cast or orthosis with 20 degrees of plantar flexion initially, later with the correction of the equine;
- anticoagulant treatment during immobilization;
- walking with axillary crutches without support 4-6 weeks.
Complications that may occur after surgical treatment are:
- re-rupture – 2% compared to 10-40% in the case of orthopedic treatment;
- more common infectious complications in smokers, women, steroid treatment, open / percutaneous technique;
- vasculonervical complications, sural nerve injury, more common in percutaneous technique.
Regardless of the treatment chosen, orthopedic or surgical , it must be followed by a medical recovery treatment.
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