ANATOMY

The Achilles tendon is the tendon that connects the calf muscle (gastrocnemius) to the heel bone (calcaneus). This is the tendon that is just below the skin at the back of the ankle. As with most tendon injuries, this tendon may be injured.

Figure 1: Lateral (Side) View of RightFoot

FUNCTION

When the gastrocnemius muscle (in the calf) contracts (shortens), the tendon which is attached from the muscle to the heel bone (calcaneus) moves. As the muscle shortens, the tendon moves to point the foot downwards. This is the action that allows a person to stand on one's toes, to run, to jump, to walk normally, and to go up and down stairs.

TYPES OF INJURIES

Achilles tendonitis is an inflammation of the tendon. It often results from a small stretch injury that causes the tendon to become swollen, painful and less flexibility than the normal tendon. Untreated, this injury may fail to heal, or progress to a chronically painful condition. Of course, in some people, the tear may progress to a complete rupture of the tendon. A ruptured (or torn) tendon may occur when the tendon has been structurally weakened by an ongoing tendonitis, or when a completely healthy tendon is subjected to a sudden, unexpected force. As a result, the tendon tears. When the tendon tears, people often report hearing a pop at the back of the ankle. If they are playing doubles in tennis, the person often thinks that his/her partner has hit them in the back of the ankle. With the injury, pain, swelling, and loss of function occur. Since the calf muscle is no longer attached to the heel bone, people find it difficult to walk normally, and have difficulty doing activities that require any type of significant push off with their toes (such as running, jumping, doing toe raises). Left untreated, the tendon often fails to heal, thereby resulting in a permanent disability.

DIAGNOSIS

For a tendon rupture, the area of the rupture is often swollen, tender, bruised (ecchymotic), and may actually have a palpable gap in the tendon. X-rays, although they do not show the tendon reliably, do show the calcaneus. When doing the x-ray, the physician is checking to see if the bone to which the Achilles tendon attached (calcaneus) has been injured. In some cases, the tendon will not tear; but instead, it will literally pull a piece of calcaneal bone off of the rest of the calcaneus. Although this is repairable, the technique is different then merely sewing the two ends of a ruptured tendon together. If the tendon has not ruptured, then the patient may have sustained only a pulling injury to the tendon. This type of injury results in a stretch injury to the tendon which is called tendonitis. Although this often heals without surgery, until completely healed, the tendon is structurally weaker then normal and is at an increased risk for tearing with continued athletic activity or additional injury producing situations. The most reliable diagnostic study for a suspected rupture of the Achilles' tendon is the Thompson test. This is a test performed during the physical exam. When then test is abnormal, the probability of a ruptured tendon being present is extremely high.

Figure 2: Side View of Ruptured Achilles’ Tendon. Notice depression at site of rupture (red circle).

TREATMENT

The treatment options for a complete rupture of the tendon include surgery followed by casting, or casting alone. There are advantages and disadvantages to each technique and the options should be discussed with your physician. With surgery, the tendon is either reattached to the calcaneal bone (if it has been pulled off or avulsed) or the two ends are sewn together is the tendon has been torn in two. In most people, a cast is applied after surgery until healing is complete. Each patient must be considered individually. There are many reasons why a person may not be a suitable candidate for a surgical repair of the injury. These include, but are not limited to: poor circulation, presence of skin problems at the site of the injury, age, a sedentary lifestyle, other medical conditions that make the person a poor candidate for surgery (such as heart or lung problems). If the injury is treated non-operatively, then a cast is applied until healing is complete. The length of time required for healing is highly variable. Often it may take as long as six months for complete healing to occur.

THIS MATERIAL DOES NOT CONSTITUTE MEDICAL ADVICE. IT IS INTENDED FOR INFORMATIONAL PURPOSES ONLY. PLEASE CONSULT A PHYSICIAN FOR SPECIFIC TREATMENT RECOMMENDATIONS.

THE CENTER FOR ORTHOPAEDICS & SPORTS MEDICINE

1211 Johnson Ferry Rd
Marietta, GA 30068
770-565-0011
http://www.arthroscopy.com