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Heel Cord Injury (Tendo Achilles Rupture) Print

Achilles Tendon Rupture

Has been known since the time of Hippocrates. With 0.2% incidence, rupture of the achilles tendon is the most common lower extremity tendon injury.

How does it happen?

Achilles tendon rupture is commonly seen  between 30-40 years old is 5 times more common in men. Rupture occurs more often on the left side.

Sedentary individuals and regular indirect trauma during sporting activity are often given in history. Sudden unexpected upward movement of the ankle with powerful calf muscle contraction may cause the rupture. Sudden raising on tiptoes on weightbearing leg while knee in extension (frequently in tennis), sudden excessive dorsiflexion of plantar flexed ankle like falls from height may also cause heel cord ruptures.

Achilles Tendon rupture is more common in following conditions:

Rheumatoid Arthritis, Gout Arthritis, SLE, Renal Failure, Hyperthyroid, Infections, Tumors, Using quilone group antibiotics. corticosteroid usage, positive Achilles tendon symptoms.

Patients usually have a misperception of being hit behind. Usually they hear a loud noise which is heard by others too. There may be a swelling and difficulty in walking. However, it is very rarely painful.

 

Diagnosis

 

Diagosis is usually done with physical examination. Associated symptoms are: Edema in ankle and foot, a gap palpated in rupture area, positive Thompson test, unability to raise on tiptoes.

Radiological Study

Direct radiology may help in avulsiion injuries. If one can not make sure of the diagnosis, MR is helpfull.

Treatment

Surgery is the first treatment choice in active young patients. Conservative treatment can be selected in elder and sedative patients. Plaster application followed by  the physical therapy is the preferred conservative treatment.

Surgical technique used with mini-incision (3-4 cm) has been popularizated by Prof.Dr.Şeref Aktaş. In this way,   recovery time and operative time are shorter than conventional surgery. Results are better with surgical treatment with early mobilization. Recurrent tear incidence is also lower in surgical treatment than the conservative treatment.

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