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Ruptures of the Achilles Tendon

Rupture of the Achilles tendon is one of the most devastating injuries which the competitive and recreational athlete can suffer.   Overall it is not as common an injury as, for example, tendonitis of the elbow, but it is much more difficult to treat in the higher levels of competitive sports.   Although it is not entirely avoidable, there is much that can be done to reduce your chances of suffering such an injury.

First it is necessary to understand the anatomy of the area.  The tendocalcaneus (Achilles tendon) is the thickest and strongest tendon in the human body.  It is approximately 15 cm long and begins in the mid-aspect of the calf and extends distally (towards the foot) to its insertion on the heel bone (calcaneus).  It actually originates from three separate muscles which join together to form the strong muscular group which is responsible for pushing the foot downward to provide the push-off for propelling the body forward.  This is especially accentuated in sports such as squash where a rapid push-off is required.  It is obvious, therefore, that when this tendon ruptures it is a major injury.

The classic history of the injury is that it usually occurs in males, although it certainly occurs in females as well.  It most commonly affects people aged 30-50 but can cross all age groups.  Unfortunately, it can particularly affect athletes and will simply occur as they are pushing off to reach forward, although it has been known to occur when the athlete is simply in the ready position anticipating forward movement.  The classic story is that the athlete feels a sudden pain in or just below the calf and, due to the sudden nature of the pain and the sensation of a direct blow, turns around to see who hit him with the tennis ball.   The sudden pain stops play immediately and medical attention should be sought without delay.

The medical and surgical treatment is controversial at times.  This is mostly related to the fact that treatment is difficult and there is no one simple answer to the problem.  The leg can either be operated on or casted for a prolonged period of time, and there are proponents of both types of treatment.  However, with either treatment there is a long period of casting and immobilization of up to ten weeks with a long and arduous course of physiotherapy after the casting is over.  Surgical repair is most commonly advocated for the more distal (lower) injuries which are closer to the insertion on the calcaneus (heel bone).   Often at higher levels of competition it is a career-ending injury in spite of vigorous surgical or casting treatment.  Although the athlete is able to recover, they rarely attain the high level of sport which they were at prior to the injury.

It is obvious that the best thing to do with the injury is to avoid it in the first place.  This can be done very simply with stretching exercises prior to the workout.  All stretching exercises, whether they are done for the Achilles tendon or for any other muscle group in the body, should be done with the speed of a glacier; that is to say that they should not be rapid twisting motions or pumping motions up and down.  The affected area should be put on a stretch and then held for 15 seconds just below the feeling of discomfort.  The best way to determine exactly how much of a stretch should be put on a limb is strained but still comfortable.  The stretch should be held for 15 seconds and repeated several times prior to workout if the best results are to be obtained.  This also promotes flexibility as well as protecting the tendon from injury.

By far the best treatment of this injury is prevention itself and although the stretching exercises do take a few minutes of time, they are well worth the effort and should be part of every athletes warm-up to avoid this devastating injury.