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 percent report premorbid symptoms, posterior calf or heel pain due to running sports (Soma and Mandelbaum, "Repair" 239-247).

The Achilles tendon is very susceptible to acute and chronic injury due to its structural and functional demands. Long-term or repetitive loads can cause tendinitis and short-term, rapid loading can cause traumatic rupture of the tendon. Causes are attributed to intrinsic and extrinsic factors. The Achilles tendon is the strongest and largest tendon in the body; it is subject to the highest of forces in the body. During running, tensile loads of up to eight times body weight are experienced. The soleus muscle component crosses only the ankle joint; it is the most subject to early disuse atrophy

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ning soreness with markedly increasing pain with activity. Sudden severe pain in the Achilles region with marked disability indicates a complete rupture. Pain that is noticed on rising in the morning that diminishes with walking or heat, usually indicates Achilles tendinitis or retrocalcaneal bursitis (Brukner 463-465). Rehabilitation Rehabilitation programs are slow and lengthy. When conservative management of an Achilles injury fails (three months) to improve the condition, surgery may be indicated. Surgery is then followed by an intense rehabilitation program (at least three months) before the return to a sport (Brukner 463-465). Surgical debridement of the pathologic tissue and open repair with a locking-suture technique should result in functioning that is able to withstand forces applied during aggressive rang-of-motion and progressive resistance rehabilitation program (Soma and Mandelbaum, "Repair" 239-247). Chronic Achilles tendinitis is managed by a period of complete abstinence from the inciting activity combined with intense physical therapy. If symptoms do not disappear after an eight-week period, surgical repair is the next logical step. Acute Achilles tendon ruptures usually follow oral or injectable cor
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