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Achilles Tendon


The Achilles tendon is a strong fibrous cord that connects the muscles in the back of your calf to your heel bone. If you overstretch your Achilles tendon, it can tear (rupture) completely or just partially.




achilles tendon



If your Achilles tendon ruptures, you might hear a pop, followed by an immediate sharp pain in the back of your ankle and lower leg that is likely to affect your ability to walk properly. Surgery is often performed to repair the rupture. For many people, however, nonsurgical treatment works just as well.


Rupture usually occurs in the section of the tendon situated within 2 1/2 inches (about 6 centimeters) of the point where it attaches to the heel bone. This section might be prone to rupture because blood flow is poor, which also can impair its ability to heal.


Your Achilles tendon connects the muscles in the back of your leg to your heel bone. The calf stretch exercise can help prevent an Achilles tendon rupture. To do the stretch, follow these steps: 1. Stand at arm's length from a wall or a sturdy piece of exercise equipment. Put your palms flat against the wall or hold on to the piece of equipment. 2. Keep one leg back with your knee straight and your heel flat on the floor. 3. Slowly bend your elbows and front knee and move your hips forward until you feel a stretch in your calf. 4. Hold this position for 30 to 60 seconds. 5. Switch leg positions and repeat with your other leg.


The gastrocnemius and soleus muscles (calf muscles) unite into one band of tissue, which becomes the Achilles tendon at the low end of the calf. The Achilles tendon then inserts into the calcaneus. Small sacs of fluid called bursae cushion the Achilles tendon at the heel.


The Achilles tendon is the largest and strongest tendon in the body. When the calf muscles flex, the Achilles tendon pulls on the heel. This movement allows us to stand on our toes when walking, running, or jumping. Despite its strength, the Achilles tendon is also vulnerable to injury, due to its limited blood supply and the high tensions placed on it.


Although the Achilles tendon can withstand great stresses from running and jumping, it is vulnerable to injury. A rupture of the tendon is a tearing and separation of the tendon fibers so that the tendon can no longer perform its normal function.


The Achilles tendon is a fibrous band of tissue that links the muscles in your calf to your heel. The strength and flexibility of this tendon are important for jumping, running, and walking. Your Achilles tendon withstands a lot of stress and pressure during everyday activities, as well as during athletic and recreational play. If it becomes inflamed, swollen, and irritated, it is called tendonitis.


Tendonitis might be due to overuse or damage to the area. It can cause pain down the back of your leg and around your heel. You might notice that parts of your tendon are getting thicker, and hardening, because of tendonitis. This will get worse if you don't treat it. There are 2 main types of tendonitis:


Non-insertional Achilles tendonitis. Small tears in the middle fibers of your tendon start to break it down. This causes pain and swelling. This type of tendonitis usually affects active, younger adults


Insertional Achilles tendonitis. This damage occurs in the spot where your tendon meets your heel bone. Bone spurs (extra bone growth) often form with this type. This type of tendonitis can happen at any age, even in people who are not active.


Imaging tests, such as X-ray or magnetic resonance imaging (MRI). An X-ray shows bones and can show if the tendon has become calcified or hardened, and can show bone spurs. Your doctor will use MRI most often to see how severe the tendon damage is and what treatment is best for you.


If these do not work, or if the injury is severe or complete, surgery may be considered. The type of surgery depends on the location and amount of damage to the tendon and other factors, such as the severity of the tendonitis. Some of the surgical procedures used include:


Surgery to remove your damaged tendon tissue, repair the remaining tendon, and give it extra strength by moving another tendon to the heel bone (the tendon moved there is the one that helps the big toe point down)


The Achilles tendon or heel cord, also known as the calcaneal tendon, is a tendon at the back of the lower leg, and is the thickest in the human body.[1][2][3][4][5][6] It serves to attach the plantaris, gastrocnemius (calf) and soleus muscles to the calcaneus (heel) bone. These muscles, acting via the tendon, cause plantar flexion of the foot at the ankle joint, and (except the soleus) flexion at the knee.


The oldest-known written record of the tendon being named for Achilles is in 1693 by the Flemish/Dutch anatomist Philip Verheyen. In his widely used text Corporis Humani Anatomia he described the tendon's location and said that it was commonly called "the cord of Achilles."[8][9] The tendon has been described as early as the time of Hippocrates, who described it as the "tendo magnus" (Latin for "great tendon") and by subsequent anatomists prior to Verheyen as "chorda Hippocratis" (Latin for "Hippocrates' string").[9]


Verheyen referred to the mythological account of Achilles being held by the heel by his mother Thetis when she dipped him in the River Styx as a baby to render his body invulnerable. As the heel by which she held him was not touched by the water, it was his one vulnerable spot (hence the expression "Achilles' heel") and he was eventually killed by a poison dart to the heel. The name thus also refers to the particularly disabling and painful effect of an injury to this tendon.[9] The first closed rupture was described by Ambroise Pare in the sixteenth century.[9]


The Achilles tendon is also known as the "tendo calcaneus" (Latin for "calcaneal tendon").[9] Because eponyms (names relating to people) have no relationship to the subject matter, most anatomical eponyms also have scientifically descriptive terms. The term calcaneal comes from the Latin calcaneum, meaning heel.


The Achilles tendon connects muscle to bone, like other tendons, and is located at the back of the lower leg. The Achilles tendon connects the gastrocnemius and soleus muscles to the calcaneal tuberosity on the calcaneus (heel bone).[10] The tendon begins near the middle of the calf, and receives muscle fibers on its inner surface, particularly from the soleus muscle, almost to its lower end. Gradually thinning below, it inserts into the middle part of the back of the calcaneus bone. The tendon spreads out somewhat at its lower end so that its narrowest part is about 4 cm (1.6 in) above its insertion.[11]


The tendon is covered by the fascia and skin, and stands out prominently behind the bone; the gap is filled up with areolar and adipose tissue. A bursa lies between the tendon and the upper part of the calcaneus. It is about 15 centimetres (6 in) long.


Along the side of the muscle, and superficial to it, is the small saphenous vein. The sural nerve accompanies the small saphenous vein as it descends in the posterior leg, traveling inferolateral to it as it crosses the lateral border of the Achilles tendon.[12] The tendon is the thickest tendon in the human body.[11] It can receive a load stress 3.9 times body weight during walking and 7.7 times body weight when running.[13]


Acting via the Achilles tendon, the gastrocnemius and soleus muscles cause plantar flexion of the foot at the ankle. This action brings the sole of the foot closer to the back of the leg. The gastrocnemius also flexes the leg at the knee. Both muscles are innervated by the tibial nerve.[14] Because the fibres of the tendon spiral about 90 degrees, fibres from the gastrocnemius tend to attach to the outer part of the bone, whereas fibres from the soleus tend to attach closer to the midline.[11]


Vibration of the tendon without vision has a major impact on postural orientation.[15] Vibration of the tendon causes movement backwards and the illusion of a forward body tilt in standing subjects.[16] This is because vibrations stimulate muscle spindles in the calf muscles. The muscle spindles alert the brain that the body is moving forward, so the central nervous system compensates by moving the body backwards.


Inflammation of the Achilles tendon is called Achilles tendinitis. Achilles tendinosis is the soreness or stiffness of the tendon, particularly worse when exercising, and generally due to overuse.[17] The most common symptoms are pain and swelling around the affected tendon.[18] The pain is typically worse at the start of exercise and decreases thereafter.[19] Stiffness of the ankle may also be present.[20] Onset is generally gradual.[18]


Achilles tendon degeneration (tendinosis) is typically investigated with either MRI or ultrasound. In both cases, the tendon is thickened, may demonstrate surrounding inflammation by virtue of the presence of paratenonitis, retrocalcaneal or retro-achilles bursitis. Within the tendon, increased blood flow, tendon fibril disorganisation, and partial thickness tears may be identified. Achilles tendinosis frequently involves the mid portion of the tendon but may involve the insertion, which is then known as enthesopathy. Though enthesopathy may be seen in the context of advancing age, it is also associated with arthritis such as gout and the seronegative spondyloarthritides. Achilles tendinosis is a known risk factor for calf muscle tears.[24]


Achilles tendon rupture is when the Achilles tendon breaks.[25] Symptoms include the sudden onset of sharp pain in the heel.[18] A snapping sound may be heard as the tendon breaks and walking becomes difficult.[26]


Rupture typically occurs as a result of a sudden bending up of the foot when the calf muscle is engaged, direct trauma, or long-standing tendonitis.[26][25] Other risk factors include the use of fluoroquinolones, a significant change in exercise, rheumatoid arthritis, gout, or corticosteroid use.[27][25] Diagnosis is typically based on symptoms and examination and supported by medical imaging.[25] Achilles tendon rupture occurs in about 1 per 10,000 people per year.[25] Males are more commonly affected than females.[27] People in their 30s to 50s are most commonly affected.[25] 041b061a72


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