Achilles Tendon Injury
Tendo Achilles is the strongest tendon of the body. It connects the bulky Gastroc-soleus muscle of the calf to the posterior aspect of heel bone (calcaneum). Blood supply of Tendo Achilles is limited. Due to this paucity of circulation micro injury of the tendon from daily activity does not heal properly and accumulates. This makes it prone for degeneration and vulnerable to injury.
Achilles tendon injury is of two types: acute traumatic or chronic degenerative. Acute rupture of Tendo Achilles usually happens in young individuals when the foot is forcefully moved upwards at the ankle and calf muscle is engaged. Commonly associated with RTA, steeping in a hole and sports related activity. or direct injury from a sharp object. This injury is associated with a contaminated local wound and exposed cut tendon.
Degenerative rupture of Achilles tendon happens due to tendon degeneration from non-insertional or insertional tendinosis and repeated loading of the tendon. Rupture usually occurs at 6 cm from its attachment with the calcaneus. There are few risk factors associated with Tendo Achilles rupture. Male ages from 30 to 40 are more prone to injury. Sports involving running, jumping, sudden starts and stops are high risk for injury. Local steroid injection around the tendon or intake of fluoroquinolone antibiotic increases rupture risk.
Acute injuries are always painful and often patients feel a pop during the injury. Patients cannot walk or stand following injury. Chronic degenerative injuries may go unnoticeable but acute injuries are always symptomatic. Most of the time one may feel being kicked off at the back of the leg, feeling a pop on snap followed by severe pain and swelling at rupture site. Inability to stand on toe tip and push off while walking. Acute injury in an active sports person is always associated with pre-existing degeneration of the tendon. Acute injuries are very obvious on clinical examination. There is always a palpable gap indicating tendon discontinuation. may not need any investigation but if there is any risk factor for tendon degeneration then an ultrasound or MRI should be done to assess the integrity and health of the tendon.
For an active athlete surgical repair or reconstruction is required with or without tendon transfer and augmentation. common tendon used for augment is flexor hallucis longus (FHL).