Working With Achilles Tendon Ruptures

posted on 07 May 2015 01:17 by needlessphiloso42
Overview
Achilles Tendonitis An Achilles tendon rupture is a complete or partial tear that occurs when the tendon is stretched beyond its capacity. Forceful jumping or pivoting, or sudden accelerations of running, can overstretch the tendon and cause a tear. An injury to the tendon can also result from falling or tripping. Achilles tendon ruptures are most often seen in ?weekend warriors? - typically, middle-aged people participating in sports in their spare time. Less commonly, illness or medications, such as steroids or certain antibiotics, may weaken the tendon and contribute to ruptures.

Causes
Often an Achilles rupture can occur spontaneously without any prodromal symptoms. Unfortunately the first "pop" or "snap" that you experience is your Achilles tendon rupture. Achilles tendon rupture most commonly occurs in the middle-aged male athlete (the weekend warrior who is engaging in a pickup game of basketball, for example). Injury often occurs during recreational sports that require bursts of jumping, pivoting, and running. Most often these are tennis, racquetball, squash, basketball, soccer, softball and badminton. Achilles rupture can happen in the following situations. You make a forceful push-off with your foot while your knee is straightened by the powerful thigh muscles. One example might be starting a foot race or jumping. You suddenly trip or stumble, and your foot is thrust in front to break a fall, forcefully over stretching the tendon. You fall from a significant height. It does appear that previous history of Achilles tendonitis results in a degenerative tendon, which can grow weak and thin with age and lack of use. Then it becomes prone to injury or rupture. Certain illnesses (such as arthritis and diabetes) and medications (such as corticosteroids and some antibiotics) can also increase the risk of rupture.

Symptoms
Patients present with acute posterior ankle/heel pain and may give a history of ?felt like someone kicked me from behind?. Patients may report a direct injury, or report the pain started with jumping or landing on a dorsiflexed foot. It is important to elicit in the history any recent steroid or flouroqunolone usage including local steroid injections, and also any history of endocrine disorders or systemic inflammatory conditions.

Diagnosis
To diagnose an Achilles tendon injury, your health care provider will give you a thorough physical exam. He or she may want to see you walk or run to look for problems that might have contributed to your Achilles tendon injury.

Non Surgical Treatment
Your doctor will advise you exactly when to start your home physical therapy program, what exercises to do, how much, and for how long to continue them. Alphabet Range of Motion exercises. Typically, the first exercise to be started (once out of a non-removable cast). While holding your knee and leg still (or cross your leg), you simply write the letters of the alphabet in an imaginary fashion while moving your foot and ankle (pretend that the tip of your toe is the tip of a pencil). Motion the capital letter A, then B, then C, all the way through Z. Do this exercise three times per day (or as your doctor advises). Freeze a paper cup with water, and then use the ice to massage the tendon area as deeply as tolerated. The massage helps to reduce the residual inflammation and helps to reduce the scarring and bulkiness of the tendon at the injury site. Do the ice massage for 15-20 minutes, three times per day (or as your doctor advises). Calf Strength exercises. This exercise is typically delayed and not used in the initial stages of rehabilitation, begin only when your doctor advises. This exercise is typically done while standing on just the foot of the injured side. Sometimes, the doctor will advise you to start with standing on both feet. Stand on a step with your forefoot on the step and your heel off the step. The heel and forefoot should be level (neither on your tip toes nor with your heel down). Lower your heel very slowly as low as it will go, then rise back up to the level starting position, again very slowly. This is not a fast exercise. Repeat the exercise as tolerated. The number of repetitions may be very limited at first. Progress the number of repetitions as tolerated. Do this exercise one to two times per day (or as your doctor advises). Achilles Tendonitis

Surgical Treatment
The procedure generally involves making an incision in the back of your lower leg and stitching the torn tendon together. Depending on the condition of the torn tissue, the repair may be reinforced with other tendons. Surgical complications can include infection and nerve damage. Infection rates are reduced in surgeries that employ smaller incisions. Rehabilitation. After treatment, whether surgical or nonsurgical, you'll go through a rehabilitation program involving physical therapy exercises to strengthen your leg muscles and Achilles tendon. Most people return to their former level of activity within four to six months.

Prevention
Prevention centers on appropriate daily Achilles stretching and pre-activity warm-up. Maintain a continuous level of activity in your sport or work up gradually to full participation if you have been out of the sport for a period of time. Good overall muscle conditioning helps maintain a healthy tendon.