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ACHILLES TENDON RUPTURE.
Term Paper ID:24470
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Essay Subject:
Causes & effects, treatment & rehabilitation, prevention.... More...
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7 Pages / 1575 Words
6 sources, 19 Citations,
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Paper Abstract:
Causes & effects, treatment & rehabilitation, prevention.
Paper Introduction:
ACHILLES TENDON
Introduction
Achilles tendon rupture is a common injury for this body region. This research paper discusses the tearing and rupture of the Achilles, rehabilitation process, and injury prevention.
Achilles Tendon
Achilles tendon rupture is increasingly common. Incidence of rupture is more common in countries where work is more sedentary and it is decreased in countries where physical work is common. Increased incidence has also been found in people with blood group O (Soma and Mandelbaum, "Achilles Tendon" 811-823).
The male to female incidence ratio for acute Achilles Tendon ruptures varies from 2:1 to 12:1. Reports show that 75 percent of all cases occur in athletes, ages 30 years to 40 years; 15
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Conclusion The Achilles tendon is a common place for injury. Mills. Pain onset is sudden in a partial tear of the Achilles tendon; itcauses little morning soreness with markedly increasing pain with activity. Achilles tendon injury is the mostcommon cause of injury for this region. Achilles Tears & Ruptures The Achilles tendon is very susceptible to acute and chronic injurydue to its structural and functional demands. This procedure isan open repair using Krackow suture technique, followed by early activerange of motion with minimal immobilization and progressive rehabilitationprogram (Soma and Mandelbaum, "Achilles Tendon" 811-823). Doctors argue over which option is optimal. Surgery is then followed by anintense rehabilitation program (at least three months) before the return toa sport (Brukner 463-465). These conditions include the following:increases in activity (mileage, speed, gradient), decreases in recoverytime between training, changes of surface or footwear (lower heeled spike,shoe with heel tab), poor footwear (inadequate heel counter, increasedlateral flaring, decreased forefoot flexibility), excessive pronation(increased load on gastrocnemius/soleus complex to resupinate the foot fortoe-off), poor muscle flexibility (tight gastrocnemius), and decreases injoint range of motion (restricted dorsiflexion). Doctors recommend steps toward preventing injury to be carried out bythe athlete and assisted by the athletic trainer. Ruptures occur with rapideccentric loading. The Achilles tendon iscovered by the peritenon alone, there is no synovial sheath around it (Somaand Mandelbaum, "Repair" 239-247). Works CitedAlfredson, Hakan, Tom Pietila, and Ronny Lorentzon. The chronic rupture of the Achilles tendon is adebilitating injury that has been difficult to treat effectively.Untreated ruptures leave the patient with a considerable degree ofdisability. Tendinitis that isnot managed may result in Achilles tears and rupture. The Achilles tendon is the strongest and largest tendonin the body; it is subject to the highest of forces in the body. Generalized tightness ofthe calf muscles will predispose the athlete toward Achilles tendon injury;this needs to be corrected with a structured stretching program and softtissue massage. Achilles tendinitis is a common injury in sport; it effects maturemale athletes engaged in running and jumping activities. Mobilization of the ankle or subtalar joints is necessaryto avoid reduced range of motion in these joints which places increasedload on the Achilles tendon (Brukner 463-465). Trainers can assist in injuryprevention with alteration of predisposing factors. Observations show thatimmobilization is associated with muscle atrophy, joint stiffness,cartilage atrophy, adhesion formation, and deep vein thrombosis;immobilization has been shown to be the factor most responsible for tendonsurgery complications. Ruptures that are seen late may only be treated by surgery(Wapner, Hecht, and Mills 249-263). "Reconstruction of Neglected Achilles Tendon Injury." Orthopedic Clinics of North America 26.2 (1995): 249-263.----------------------- 3 Taping will also reduce the excursion of theAchilles tendon. Troop, Losse, Lane, Robertson,Hastings, and Howard also studied patients treated with limitedimmobilization and early motion after repair of ruptures. "Achilles Tendon Disorders." Foot and Ankle Injuries 13.4 (1994): 811-823.---. Increased incidencehas also been found in people with blood group O (Soma and Mandelbaum,"Achilles Tendon" 811-823).The male to female incidence ratio for acute Achilles Tendon rupturesvaries from 2:1 to 12:1. Surgical debridement of the pathologic tissueand open repair with a locking-suture technique should result infunctioning that is able to withstand forces applied during aggressive rang-of-motion and progressive resistance rehabilitation program (Soma andMandelbaum, "Repair" 239-247). A pop is felt by thepatient. Long-term or repetitiveloads can cause tendinitis and short-term, rapid loading can causetraumatic rupture of the tendon. Treatment of Achilles tendon ruptures has been subject to controversyfor the last 2 years. Pain that is noticed on rising in the morning thatdiminishes with walking or heat, usually indicates Achilles tendinitis orretrocalcaneal bursitis (Brukner 463-465). ACHILLES TENDON Introduction Achilles tendon rupture is a common injury for this body region.This research paper discusses the tearing and rupture of the Achilles,rehabilitation process, and injury prevention. Jogging should only be commenced and increased gradually,as long as there is no pain during or after exercise. Gradual return to activity is another consideration. Resultsdemonstrated that this is a safe technique with no increased risk ofrerupture. Options include closed techniques with below-kneecasting in plantar flexion for eight weeks, open or percutaneous surgicalrepair with casting for eight weeks, and a new method. Operative patientshave demonstrated increased strength and decreased re-rupture rates.Doctors must now choose the most cost-effective method of treatment. If symptoms do not disappear after an eight-week period, surgicalrepair is the next logical step. "Early Motion After Repair of Achilles Tendon Ruptures." Foot & Ankle International 16.11 (1995): 7 5-7 9.Wapner, Keith L., Paul J. Achilles Tendon Achilles tendon rupture is increasingly common. Causes are attributed to intrinsic andextrinsic factors. Mandelbaum. Pain in the Achilles tendon region is the common presenting symptom,particularly with distance runners. Acute Achilles tendon ruptures usuallyfollow oral or injectable corticosteroid administration. Hastings, and Mark E. Short-term may not be intense, but the onset of edema andecchymosis causes discomfort and an inability to continue activity (Somaand Mandelbaum, "Repair" 239-247). When conservativemanagement of an Achilles injury fails (three months) to improve thecondition, surgery may be indicated. The athlete's shoes areimportant. When rehabilitativeand preventative measures fail to relieve symptoms, surgery may beindicated. Patients found good return of plantarflexion strength, power,and endurance (7 5-7 9). Needs for surgical treatment increase with age,symptom duration, and tendinopathic changes (Alfredson, Pietila, andLorentzon, 829-833). Robertson, Pamela S. The foot and ankle are in dorsiflexionand the knee is extended with a contracted soleus muscle in rapid eccentricloading where these injuries usually occur. "Repair of Acute Achilles Tendon Ruptures." Orthopedic Clinics of North America 26.2 (1995): 239-247.Troop, Randal L., Gary M. These situations are harder to treat surgically than the acutetendon rupture. Benefits have been shownfrom operative intervention; others show no significant differences betweenresults from operative and nonoperative treatments. Results of a study of this technique demonstratedthat by six weeks, 9 percent of patients show full range of motion and bysix months, 92 percent returned to sports participation (Soma andMandelbaum, "Achilles Tendon" 911-823). Factors thatpredispose to Achilles tendon injury are noted for primary and secondaryprevention (part of treatment). The tendoncommonly tears (2 to 6 cm) from the calcaneus. The soleus muscle fibers are type I (slow twitch,oxidative metabolism) and the Achilles tendon therefore has a significantpotential for rapid atrophic change with disuse. Intrinsic factorsare found to include abrupt increases in the duration, intensity, orfrequency of running leading to an inflammatory condition from overuse.Extrinsic factors include athletic shoes with an inadequately padded heelwedge or a soft heel counter with a lack of stabilization of the hindfoot.Pathogenetic factors are tibia vara, tight or underdeveloped hamstrings,and the cavus foot (Soma and Mandelbaum, "Achilles Tendon" 811-823). Incidence of ruptureis more common in countries where work is more sedentary and it isdecreased in countries where physical work is common. If a patient is ableto jog comfortably for 45 minutes, the speed can be gradually increased.At a later time, sprint work and hill running can be slowly introduced.Track work in spikes with lowered heels should be approached with caution(Brukner 463-465). "Sports Medicine Pain in the Achilles Region." Sports Medicine 26.4 (1997): 463-465.Soma, Charles A., and Bert R. Activity shouldonly be resumed when local tenderness is settled. Theprolonged cast and immobilization was the major staple of Achilles tendonrupture care for operative and nonoperative cases. Losse, John G. Sudden severe pain in the Achilles region with marked disability indicatesa complete rupture. Research shows that cast immobilization results ina patient never returning to maximal levels of functioning (Soma andMandelbaum, "Achilles Tendon" 811-823). Chronic tears of the achilles tendon result in a lengthening of thetendon from progressive microtear and scarring or a large, fixed gap fromcomplete rupture, with secondary contraction and fibrosis of thegastrocnemius-soleus complex after an inadequately diagnosed or treatedrupture. Lane, Daniel B. Two bursae may become inflamed andproduce symptoms, the retrocalcaneal bursa (lies between the posterioraspect of the calcaneus and the insertion of the Achilles tendon) and theAchilles bursa (lies between the insertion of the Achilles tendon and theskin). Rehabilitation Rehabilitation programs are slow and lengthy. Studies show increased incidence for those medicated with eitheroral or injectable corticosteroids. It is postulated that repetitive microtrauma causes tendon failure.Others have shown a decreased vascular perfusion of the Achilles tendoncomplex. "Chronic Achilles Tendinitis and Calf Muscle Strength." The American Journal of Sports Medicine 24.6 (1996): 829-833.Brunkner, Peter. Duringrunning, tensile loads of up to eight times body weight are experienced.The soleus muscle component crosses only the ankle joint; it is the mostsubject to early disuse atrophy during undertraining or short-leg castimmobilization. Howard. The doctor, athlete, and trainer need to assess for abnormal footbiomechanics such as excessive subtalar pronation which commonlypredisposes toward Achilles tendon injuries. Newfindings indicate that the Krackow procedure with quick return tomobilization offers optimal results. Krakow presented a new suture technique in 1986; it permits a securebut nonstrangulating soft tissue approximation. Reports show that 75 percent of all cases occurin athletes, ages 3 years to 4 years; 15 percent report premorbidsymptoms, posterior calf or heel pain due to running sports (Soma andMandelbaum, "Repair" 239-247). Doctors must determine which surgical technique to employ. At this point, nonoperative options carry a higherrerupture rate and a lower ultimate performance rate (Soma and Mandelbaum,"Achilles Tendon 811-823). Hecht, and Robert H. Chronic Achilles tendinitis is managed by a period of completeabstinence from the inciting activity combined with intense physicaltherapy. An eight percent strain, thetendon will fail and break the collagen cross links. Inadequate rear foot support or control must be considered aswell as the design of the shoe (Brukner 463-465). These variables lead toprolonged loading, which results in microtrauma, chronic low levelinflammation, and tissue thickening (Brukner 463-465). Patients are notimmobilized postoperatively and are started on early range of motion andconditioning programs. Returning to activityneeds to be accompanied by a heel raise to reduce the load on the Achillestendon, in both shoes. However, castimmobilization has been shown to be traumatic. Prevention Correcting pathologic circumstances will reduce chronic tendinitissymptoms and prevent rupture (Soma and Mandelbaum 239-247).
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