Achilles tendon injury
What is an Achilles tendon tear?When one speaks of an Achilles tendon rupture or Achilles tendon rupture, one means a complete transection of the Achilles tendon.
The Achilles tendon connects the heel bone with the calf muscles. As the strongest tendon of the human body, it is indispensable for walking and running.
It ensures that the heel can stand out from the ground. If it is severed in whole or in part, it is called an Achilles tendon rupture or Achilles tendon rupture.
This occurs suddenly and announces itself only in rare cases before by pain. In most patients, it is hidden, that is without external injuries.
Possible, but less known in practice, is a tear of the Achilles tendon due to external influences such as the effect of glass or sharp-edged objects.
The Achilles tendon tear is a typical sports injury. Constant sports and other stresses lead to signs of wear, which then exceed the mechanical strength of the tendon tissue in case of sudden tension or a kick.
Sports with a very fast change of direction (eg handball or football) promote the frequency of the injury. Pre-existing conditions such as diabetes mellitus promote the limitation of exercise capacity. Men are more affected by this injury than women.
The Achilles tendon rupture is clearly audible and goes hand in hand with a bang (whip bang). This is followed by severe pain in the heel area. Above the heel a dent is clearly palpable. In an Achilles tendon rupture, the patient can no longer walk on tiptoe.
Symptoms, complaints & signs
An Achilles tendon tear is primarily associated with very severe pain. These usually occur directly on the tendon on the foot and can also radiate into the neighboring regions. This leads to very strong [pain in the entire foot]] and usually also on the affected person's leg.
Furthermore, the patients suffer from a bleeding at the affected region and associated with a strong swelling. The pain also occurs during the night due to the Achilles tendon rupture, so that most patients also suffer from sleep disorders or depression and irritability. The quality of life is honestly restricted.
There are restrictions in the movement and thus also strong restrictions in the everyday life of the person concerned. Ordinary movements are no longer possible for the person concerned. The Achilles tendon tear reduces the total load capacity of the foot, so that even strenuous activities can not be carried out without further ado.
It usually takes a few months for the strength of the foot to be restored. A loss of power can also occur through this crack. Due to the severe restrictions in everyday life, some sufferers also suffer from mental discomfort or depression due to the tear.
Diagnosis & History
Various procedures are used for diagnostics. The doctor will usually perform the calf compression test after Thompson at the beginning. Furthermore, imaging methods such as ultrasound and X-rays are used.
The prognosis for Achilles tendon rupture to completely restore the resilience of the foot depends to a great extent on the treatment measures and the athletic demands of the patient.
An Achilles tendon tear that is not treated usually leads to a loss of strength. Although a tendon regeneration develops within two to four months, it does not represent a complete replacement of the Achilles tendon.
In contrast, professional therapy and consistent follow-up treatment almost always restore the resilience of the Achilles tendon. For competitive athletes, the prognosis, however, can turn out far more negative and lead to the end of their careers.
An Achilles tendon rupture can be prevented by avoiding fast, abrupt and extreme strain.
If an Achilles tendon tear is operated, nearby structures may be injured. It can cause bruising, bleeding, bleeding and circulatory disorders. If nerves are injured, sensory disturbances and symptoms of paralysis can occur.
In addition, anesthesia also carries a certain risk. It can also lead to wound healing disorders, wound infections, excessive scarring and infections. The tendon may shorten or lengthen. If a blood stasis cuff is used, pressure damage, such as paralysis, can be caused.
After surgery, prolonged swelling may occur. The swelling can cause problems in the subsequent therapy - for example, when adjusting the shoes. Sensory disturbances may occur in the area of the surgical scar.
An Achilles tendon tear usually creates a bandage. The pressure in the dressing can cause damage to vessels and nerves. Muscles and bones can become weaker due to limited movement. It can also come to a so-called Sudeck syndrome. The bone is greatly degraded and it results in a painful inflammation. Blood clots can also form. In addition, allergic reactions can occur with varying degrees of severity.
After an Achilles tendon tear increases the risk of a leg vein thrombosis. In addition, it can lead to a new tear, a so-called re-reptile. Overall, the Achilles tendon may be limited in its function after a tear.
When should you go to the doctor?
An Achilles tendon tear should be treated as soon as possible. A visit to a doctor is recommended for suspected serious injury to the Achilles tendon. Anyone who suddenly feels a strong pain in the tendon area during sport, possibly with a whiplash sound, should go to the doctor immediately. This is especially recommended if the symptoms persist after exercise or strengthen rapidly.
If the foot can not be unrolled as before, there may be an Achilles tendon rupture that needs to be treated. Limitations of movement of the toe (the foot can no longer be "bent down") indicate an injury requiring treatment.
In general, complaints in the area of the calves or heels, which persist after the usual regeneration phase, must be medically clarified and, if necessary, treated. For acute pain first aid measures in the form of cooling wrap and protection should be taken. In severe pain or paralysis in the foot of an ambulance service should be turned on.
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Treatment & Therapy
First of all, it is important to initiate the correct immediate measures for an Achilles tendon rupture. The foot must be relieved, cooled, bandaged and raised.
Depending on the personal factors of the patient, the doctor can decide between conservative and operative therapy. Even if one decides in most cases to an operation, one will resort to the non-operative method of treatment if certain conditions are fulfilled. The risk factors include, in particular, age, smoking, possible arterial circulatory disorders or the use of certain medications.
By a solid bandage (bandage, plaster, orthosis), the injured foot is initially made quiet about a week in the Spitzenfußstellung. This is followed by the supply of a special shoe with removable heel lift for a period of about 6 weeks.
During surgery, the two ends of the Achilles tendon are rejoined. The suture can be reinforced by the muscle of adjacent muscle. The operation is followed by physiotherapeutic measures to restore mobility as quickly as possible.
Here, too, a special shoe provides a gradual increase in the load on the Achilles tendon. A longer immobilization of the lower leg is not recommended for an Achilles tendon tear.
Outlook & Forecast
In most cases, an Achilles tendon rupture can be treated surgically. Depending on the time of the intervention and the constitution of the patient, the original flexibility of the tendon can usually be restored. However, as a result of surgery, redness and itching as well as thickened areas and scars may remain, which can lead to movement disorders. Despite successful therapy, some patients complain of swelling, pain, or lower resilience of the affected leg.
Rarely, it can also lead to infections, circulatory disorders or a shortening of the tendon. With freshly healed tears there is a risk that the tendon tears again and needs to be treated again. In general, an Achilles tendon rupture requires several months of post-treatment. After three to four months, the injury should have healed and the affected person may be back to sports. The competition training should be restarted at the earliest six months after a tendon tear. Otherwise, there may be another rupture and the onset of chronic discomfort.
The risk of further injury and chronic pain is mainly in older patients who have already suffered a tear of the Achilles tendon. If there is another disease of the tendons, joints or muscles, this can also influence the prognosis.
An Achilles tendon tear is treated surgically to restore the functioning of the calf muscles and thus walking in its normal course. In order to make the regeneration optimal, aftercare by the patient and the physician is important. Physiotherapists are also involved in the aftercare process.
Essentially, it's about having the stitched Achilles tendon healed to its full extent again, so that it can fulfill its function properly again. For this, it is important that the tissue is not overused for a period of time determined by the physician. Especially athletes who, understandably, would like to start training again, should not strain the Achilles tendon too soon or too intensively.
Light dosages at the beginning of the workout are just as important as breaks for regeneration between units. Consistent pre-stretching is as important as post-tension post-stretching. Both are gentle and must not cause any pain. Particular focus is placed on the calf muscles, which exerts direct pull on the Achilles tendon and therefore must not be shortened.
Footwear is an essential factor in the aftercare of an Achilles tendon tear. Because high heels favor the cramping of the muscles of the calf and thus provide indirectly for heavy stress on the Achilles tendon. Flat shoes are much cheaper in this context, as well as barefoot running.
You can do that yourself
As with most acute sports injuries, the Achilles tendon rupture has good opportunities to help itself. Physicians recommend patients the PECH rule, which is also used in first aid. Even sprains and fractures can be optimally cared for on their own.
The individual letters of the acronym stand for Pause, Ice, Compression and Supine. In detail, this means: Put the injured body part up, take care of it and, in the best case, stop moving it. Furthermore, the affected area must be cooled. This is possible either with an ice pack or a piece of cloth soaked in cold water. Behind the point Compression is the instruction to connect the injury. This not only has the reason to stabilize the affected area, but also to prevent too much blood or secretions from leaking into the surrounding tissue. In principle, however, that the dressing may not be too tight, otherwise there is a risk of aggravation. The last important step is the high camp. The injured limb should be placed on a pillow or a chair - as a rule of thumb, doctors advise that it should be higher than the heart.
However, it is important that a doctor classify the injury to prevent serious injuries before the patient starts his or her own procedures.