Achilles tendon tear

Clemens Gödel is a freelancer for the medical team.

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An Achilles tendon tear (Achilles tendon rupture) is often accompanied by a whip-like bang. The patient can no longer stand on tiptoe of the affected foot. A doctor can usually use these symptoms to determine the cause - a ruptured Achilles tendon. The crack usually has to be treated surgically. Here you can read everything you need to know about symptoms, diagnosis and treatment of a ruptured Achilles tendon!

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. S86

Achilles tendon tear: description

The Achilles tendon tear is not an uncommon injury. More than ten out of 100,000 people suffer an Achilles tendon rupture each year. Men are more often affected than women. Typically, an Achilles tendon rupture occurs between the ages of 20 and 50 years. Most of the time, the Achilles tendon tears in the middle area with poor blood circulation and less often at the bone or muscle attachment.

The Achilles tendon connects the calf muscle "Musculus Triceps Surae" with the heel bone. The triceps surae muscle enables us to lower the tip of the foot (for example when pressing the gas pedal in a car or walking on tiptoe). The Achilles tendon has a length of ten to twelve centimeters and is the strongest tendon in the body: In maximum situations it is loaded with ten times the body weight.

Achilles tendon tear: symptoms

If the Achilles tendon is torn, very typical symptoms occur. Sufferers report a sudden snap or whip-like bang, followed by a sharp stabbing pain above the heel. Walking is clearly more difficult. Above all, toe walking is no longer possible.

Swelling in the back of the ankle and calf can also indicate a ruptured Achilles tendon. Sometimes a bruise can also be seen above the heel.

Achilles tendon rupture: causes and risk factors

Most commonly, an Achilles tendon rupture is caused by sudden, strong tension on the tendon. Typical high-risk sports are soccer, sprinting, badminton, basketball, tennis and squash - activities that require rapid stop-and-go movements, sprints and sometimes even jumps. As a rule, the affected tendon has already been damaged - for example through aging processes or micro-injuries as a result of excessive exercise and a lack of training breaks. Risk factors for an Achilles tendon tear include, for example:

older age
Muscle malfunction
male gender
Use of (quinolone) antibiotics, anabolic steroids and cortisone

In addition, poor footwear, deviations in the foot axis and foot deformities promote a rupture of the Achilles tendon.

In more than 70 percent of cases, the Achilles tendon ruptures in the central area of the tendon, as this is where the blood circulation is poorest. This also makes healing difficult.

Achilles tendon tear: examinations and diagnosis

The specialists for an Achilles tendon tear (and other tendon tears) are orthopedic surgeons and trauma surgeons. The acute symptoms cause most people to go to an emergency room immediately.

First, the attending physician will ask you various questions such as:

Can you walk normally?
Did the symptoms come on suddenly?
How did the accident happen?
Has something similar happened to you before?

First of all, blood circulation, sensitivity and motor skills in the area of the lower leg and foot must be examined. In addition, the doctor palpates the Achilles tendon: If the Achilles tendon ruptures, a gap can be felt.

An important examination for suspected Achilles tendon rupture is the so-called Thompson test. To do this, the patient lies prone on a couch. His feet hang freely over the edge of the bed. The doctor then tightly squeezes the calf muscles of the affected leg, usually stretching the foot towards the sole of the foot. If the Achilles tendon ruptures, this plantar flexion does not occur - the foot does not move.

Imaging procedures

An ultrasound scan is performed to confirm the diagnosis. This allows the doctor to determine where the tendon was ruptured, how far apart the tendon ends are, and whether there are bruises. In addition, he can check whether the tendon cover has been preserved as a guide rail.

Magnetic resonance imaging (MRI) is performed in certain cases, for example in the case of unclear findings, chronic complaints and repeated ruptures. This examination is more precise than sonography and therefore already reveals discrete structural changes. Typically, the end of the Achilles tendon near the muscle has a corkscrew-like appearance when torn and the end attached to the foot has a bulge. Liquid can usually be detected in the area of the crack.

An X-ray examination is useful if bony involvement is suspected.

Differential diagnoses

Alternative diagnoses are muscle fiber tears or tendinitis. In the case of a weakness of the lower foot, it must also be taken into account that it can be a so-called S1 syndrome. S1 syndrome is caused by irritation of a nerve root in the spinal cord on the rump.

Achilles tendon tear: treatment

Emergency treatment according to the "PECH" rule can be carried out at the scene of the accident: break, ice, compression, elevation.

Conservative treatment

If the two ends of the Achilles tendon can be brought together by lowering the foot (equinus position, plantar flexion) (check by ultrasound), conservative treatment can be used. For this purpose, the patient is given a lower leg cast in an equinus foot position for two weeks. Then he has to wear a shoe orthosis for six weeks, i.e. a specially adapted shoe that is raised in the heel area. This steep position of the foot is gradually reduced.

surgery

An operation has the advantage that renewed ruptures occur less often and the tendon is then more resilient and functional than after conservative treatment. However, mainly minor surgical complications can occur.

The operation can be performed either openly or in a minimally invasive manner. Usually the two tendon ends are sewn together. If, however, the tendon quality in the area of the tear is very poor (e.g. due to wear and tear), the surgeon must either use special suturing techniques (such as stylus box plastic) or work in a piece of tendon from another part of the body (e.g. the sole of the foot).

General anesthesia is not absolutely necessary - the operation can often be performed with regional or even local anesthesia. For the operation, the patient must be lying on the prone with their feet hanging down. The surgeon must always compare both feet during the operation in order to achieve the best possible result. In all surgical procedures, attention must be paid to the nearby sural nerve so that it is not injured. This nerve runs about 10 to 15 centimeters from the heel bone on the lower leg on the outer side of the Achilles tendon.

After the operation, the patient has to wear a lower leg cast in the equinus position for four to six weeks. The incline is reduced every two weeks.

In all cases, early functional treatment must be started.

Achilles tendon tear: disease course and prognosis

The prognosis for an Achilles tendon rupture is very good with proper care. In rare cases, infections, circulatory disorders and / or a shortening or lengthening of the tendon occur.

A follow-up treatment lasting several months is necessary after both conservative and surgical therapy. The tendon is increasingly stressed in physiotherapy. Normal sporting activities are possible again three to four months after the Achilles tendon rupture. Competitive athletes, on the other hand, should allow about half a year to pass before they start competition training again.

Some patients experience chronic pain after an Achilles tendon rupture.

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