| The largest and the strongest tendon in the body is the | | | | Conservative or surgical management is used, with a |
| Achilles tendon in the distal posterior calf. Typical | | | | greater number of re-ruptures without operation. Old |
| patients with Achilles tendon rupture are men in good | | | | people, sedentary persons, those with poor skin healing |
| health from 30-50 years old and who have not | | | | and some medical conditions are more appropriate for |
| suffered major injuries or any kind of difficulty with the | | | | conservative treatment. Infections, wound or repair |
| leg before. Rupture occurs typically in people who | | | | breakdown and other complications are more |
| have not been recently active and who may indulge in | | | | common in diabetes, peripheral vascular disease and |
| infrequent physical activity such as playing weekend | | | | other conditions which impair healing. A short or long |
| sport, players known as "weekend warriors". | | | | leg cast may be applied in plantar flexion, gradually |
| The two large calf muscles, the gastrocnemius and | | | | moving the ankle up over a period of six to ten weeks. |
| the soleus, each have a tendon and these converge | | | | Once the foot is fairly flat, weight bearing can be |
| and form the Achilles tendon about 15 centimetres | | | | allowed and the patient put into an adjustable orthotic. |
| above the calcaneum. Tendons transmit forces from | | | | Surgery can be open or percutaneous and after |
| muscles to bones and to do this they have high | | | | surgery the ankle is kept plantar flexed in a plaster of |
| resilience and sufficient stiffness, good tensile strength | | | | Paris or a rigid orthosis, with the patient coming back |
| and allow 4 percent stretch before damage. Damage | | | | for the ankle to be repositioned upwards as the |
| and rupture to the fibres can occur when the stretch | | | | tendon heals, until the ankle is freed from the splint four |
| reaches 8 percent. Most of the tendon rupture and | | | | to six weeks after the repair. Shorter periods of |
| degeneration occurs where the blood supply is | | | | immobilization appear to be more successful than |
| poorest, about 2-6 centimetres up from the heel bone. | | | | longer. Overall surgical repair may have lower |
| Achilles tendon tears occur mostly in the left leg where | | | | re-rupture rates, faster return to normality and better |
| the poor blood supply is, perhaps because most | | | | strength and endurance as compared to conservative |
| people are right handed and push off more with their | | | | treatment. |
| left leg. Common injuries are on sudden foot push off, | | | | Now the physiotherapist can start the rehabilitation |
| an unexpected forcing up of the ankle and an upward | | | | program with range of motion exercises without |
| force on the ankle when pushed down. Direct trauma | | | | bodyweight, teaching a normal gait pattern and giving a |
| and general degeneration of the tendon without | | | | heel raise to limit forced dorsiflexion in walking. |
| trauma can also occur. People at risk include those | | | | Swimming and static bicycling are good initial exercises, |
| exerting themselves when they are unfit, relatively | | | | progressing gradually on to weight bearing exercises, |
| older people, steroid users and those who exert | | | | strengthening and eventually dynamic exercises such |
| themselves in extreme ways. | | | | as balance, running and jumping. Return to normal |
| Achilles tendon forces in running can be very high and | | | | activity varies in time but could be from four months |
| have been measured at six to eight times bodyweight. | | | | after the surgery. |
| The patient typically reports a sudden snap or blow to | | | | The outcome of Achilles tendon rupture is usually good |
| the rear of the lower calf, a sudden strong pain, an | | | | to excellent, with most sports people able to return to |
| ability to walk but not to run or climb stairs. On | | | | normal activities. However, the re-rupture rate is 0-5% |
| examination there may be a swollen or bruised calf, a | | | | in surgically repaired tendons and almost 40% for |
| palpable gap in the tendon and an inability to stand on | | | | those having conservative management. Patient |
| tiptoe. A history of treatment with steroids, previous | | | | education is important to continue with appropriate |
| tendon rupture or an unusually high activity level (e.g. | | | | training, stretching to reduce the chance of re-rupture |
| weekend warrior) can also be important findings. | | | | and the choice of proper footwear. |