Achilles tendon

What is the Achilles tendon?

The Achilles tendon is the strongest tendon in the human body. It connects the heel bone (the so-called calcaneus) with the calf muscles. For example, the Achilles tendon enables us to stand on tiptoes and to push off when running and jumping.

Irritations and inflammations are the most common problems with the Achilles tendon. Achilles tendon tears or ruptures can also occur. An Achilles tendon injury can be successfully treated if recognised in due time and specifically treated. The combination of the attending physician’s experience and the latest medical treatments are the key to success here.

The experts from ECOM® Excellent Center of Medicine are specialised in the treatment and therapy of Achilles tendon problems, and are nationally and internationally regarded as renowned contact partners.

What are the types of Achilles tendon injuries?

Achilles tendon injuries are quite common. Anyone – regardless of their personal circumstances or their strain while engaged in sports – can be affected by Achilles tendon problems.

In this connection we basically differentiate between an Achilles tendon irritation or inflammation and an Achilles tendon tear or rupture. While an Achilles tendon irritation or inflammation is usually treated conservatively, surgery is often the better choice with an Achilles tendon tear or rupture.

achillessehne_muenchen

Achilles tendon irritation or inflammation

Pain repeatedly comes about with an Achilles tendon irritation or inflammation if the calf muscles are strained or stretched, or if the ankle is strained for a long time. In case of recurring pain in the region of the Achilles tendon, a physician should be consulted in order to avoid complications and to exclude a possible Achilles tendon tear.

An Achilles tendon irritation is usually treated conservatively, i.e. without surgery. Various measures such as rest, cooling, special positioning of the affected foot, orthopaedic aids as well as physiotherapy are available for this purpose.

We refer to a chronic irritation or inflammation of the Achilles tendon if the problems are recurrent or arise over a longer period.

Achilles tendon tear or rupture

With an Achilles tendon tear or rupture, the tendon which connects the calf muscles with the heel bone is completely or partially severed. It often leads to severe pain. In addition, the foot can no longer be flexed downward on the ankle.

Not every torn Achilles tendon must undergo surgery. More recent studies have shown that conservative treatment can also lead to acceptable healing outcomes. However, an operation is often the better choice with young or athletically active people. The torn or ruptured Achilles tendon is operated on in this connection by means of modern suture techniques.

Various surgical procedures, which are applied depending on the size extent of the injury, are available to us with an Achilles tendon tear or rupture. The attending physician must decide which procedure is individually employed. The following basically applies: small defects usually undergo minimally invasive surgery with a small incision by means of endoscopy. A conventional or normal incision is advisable with larger defects or older ruptures/tears.

Causes of an Achilles tendon disorder

The causes of an Achilles tendon disorder are varied. Whereas inflammations and irritations are often attributed to overstrains, traumatic events usually exist with an Achilles tendon tear. An already previously injured Achilles tendon is much more susceptible to an Achilles tendon tear or rupture.

Causes of an Achilles tendon irritation or inflammation

Despite intensive research efforts, unequivocal causes of an Achilles tendon irritation or inflammation are not known to this day. For example, muscular imbalances due to strained or shortened calf muscles, weakness of ligaments on the ankles, foot deformities or problems with the knee, hip or spine can persistently strain the Achilles tendon. An inflamed Achilles tendon insertion on the calcaneus is often associated with bursitis or a calcaneal (heel) spur. The adjacent connective tissue can also be inflamed.

Causes of an Achilles tendon tear or rupture

The causes of an Achilles tendon tear or rupture are rarely external trauma, but rather a sudden, severe strain. For example, this happens during sports through movements which particularly strain the ankle. Such movements especially occur in sports which require quick sprints, sudden stops or rapid change of directions, such as when playing tennis or football.

But tears or ruptures also occur in everyday life when the tendon is suddenly overstrained; for example, because people still want to quickly run across the street with a yellow traffic light. A tendon previously injured through an inflammation or overstrain is often a contributory factor for an Achilles tendon tear or rupture.

Symptoms of an Achilles tendon tear or rupture

An Achilles tendon tear or rupture almost always occurs during a so-called “rapid power strain”, such as when sprinting or jumping. The affected person often feels a whip-like blow with subsequent weakness of the affected leg when suffering an Achilles tendon tear or rupture. As a result, the forward section of the foot can longer be flexed downward. Standing up or walking are occasionally still possible, but cause severe pain. Standing on the ball of the foot is no longer possible, and the foot can no longer be rolled over properly.

A clear indentation is palpable at the height of the tear. An experienced physician can even diagnose an Achilles tendon tear by means of clinical examination and special functional tests. Imaging procedures such as ultrasound or magnetic resonance imaging improve diagnostics.

achillessehnenriss_symptome_ecom_muenchen

Risk factors for an Achilles tendon tear

Tears on perfectly healthy Achilles tendons are extremely rare. If the Achilles tendon is without a previous injury, part of the calcaneus on the tendon insertion ruptures during a corresponding accident rather than that the tendon itself tears. Tears with weakened, previously injured Achilles tendons which have been overstrained by persistent irritations and inflammations occur more frequently.

In addition, there are other factors which increase the risk of an Achilles tendon tear: abnormal foot positions, inappropriate footwear, shortened calf muscles, insufficiently warming up before engaging in sports, repeated overstrain during sports and advanced age.

Diagnosis and therapy of Achilles tendon disorders

A specific diagnosis is crucial for successful therapy. That is why a physician will first inquire about current and former problems in the region of the Achilles tendon.

Following this is the examination regarding whether walking on tiptoes and standing on one leg are possible. The affected ankle will be assessed for function and sensitivity to pain. The region of the tendon will additionally be palpated – an indentation a few centimetres above the heel is ascertainable with an Achilles tendon tear.

Details of the injury can be determined in further imaging procedures such as magnetic resonance imaging or x-ray examination.

chillessehnenverletzung_diagnose

Conservative therapy for an Achilles tendon injury

Achilles tendon injuries can affect almost anyone. The good news is that an operation is not always necessary. In the event of an Achilles tendon irritation, conservative therapy consisting of rest, cooling, special positioning of the affected foot, orthopaedic aids as well as physiotherapy often leads to significant improvement. Severe strains and sports should be avoided during the regeneration period after an Achilles tendon irritation.

Surgery for an Achilles tendon tear or rupture

An operation is often advisable with a completely severed or ruptured Achilles tendon. Especially younger, active people benefit from the intervention in this connection, because the function of the Achilles tendon is restored after a short time.

Surgery for an Achilles tendon tear or rupture is usually implemented in a minimally invasive manner by means of endoscopy. The ends of the torn tendon are joined and sutured together here by means of a small incision.

If the tear already exists for a longer time, larger defects are present, or the tendon is particularly worn, this may possibly be strengthened. For example, this takes place with an endogenous tendon which is near the site of the operation (this procedure is known as “tenoplasty”). The conventional surgical method with a normal incision is advisable for surgery to repair older or larger defects, since better results are achieved by means of this access.

Rehabilitation after Achilles tendon surgery

After Achilles tendon surgery, rehabilitation is critically important in order to accelerate the healing process and to enable a quick return to everyday life.

Close cooperation between physician and physiotherapist is an essential component of rehabilitation after Achilles tendon surgery. That is why the experts at ECOM® Excellent Center of Medicine develop an individual rehabilitation concept together with responsible therapists – always with the goal to bring patients back into the routine of sports and everyday life as quickly as possible.

Your specialists for Achilles tendon injuries and other problems

Dr. Rembeck

“Minimally invasive surgical procedures and conservative treatment methods quickly bring patients with Achilles tendon injuries back into the everyday sports routine.”

Dr. Erich Rembeck

Specialist in Orthopaedics and Sports Medicine

Dr. Rauch

“The patient is often in an exceptional situation. The specific diagnosis and individual therapy are the keys to treatment success.”

Dr. Alexander Rauch

Specialist in Orthopaedics and Trauma Surgery, Sports Medicine and Special Trauma Surgery

prof_gllwitzer_ecom

“Arthroscopy has revolutionised joint-preserving hip surgery and enabled us to implement new treatments for hip problems.”

Prof. Dr. Hans Gollwitzer

Specialist in Orthopaedics and Trauma Surgery
Specialist in Orthopaedics, Sports Medicine and Chirotherapy

Consultation and contact for questions regarding Achilles tendon injuries

Do you have any questions with regard to the treatment and therapy for an acute or chronic Achilles tendon injury? Our experts Dr. Erich Rembeck and Dr. Alexander Rauch will gladly inform you and provide detailed advice in a personal conversation. Simply arrange an appointment. We look forward to meeting you.