Institute for Sports Medicine Frankfurt Main

1. Risk kinds of sport:

High-jump, long-jump, gymnastics, long-distance run, Soccer

2. Anatomy

The Achilles' tendon in an educated manner by the connection two final chords once the superficially running Musculus gastrocnemius and the somewhat more deeply running Musculus soleus. The M. gastrocnemius begins with 2 heads at the rear lower part of the thigh bone and runs downward up to the heel bone, the Calcaneus. Soleus rises from the M. from the upper rear part of the shinbone and the calf leg head, draws downward and its strong chord connects itself with the final chord M. gastrocnemius and sets as Achilles' tendon at the heel bone. They form both together that Musculus triceps surae, a strong muscle, that the rear surface of the lower leg with humans as a so-called calf bulges out.

3. Function:

The calf muscle bends the foot downward. It is in the conditions, the weight of the body when standing to lift a going and a running. Its strength becomes particularly clear with the point dance, with which a maximum aspect ratio of the foot is necessary. The Achilles' tendon transfers the strength of the muscle on the foot.

4. Injury mechanism:

- eccentric stretch with itself krä;ftig harnessing Muskel
- acute traumata, like e.g. bruises or footsteps against the Achilles tendon
- Extrembelastungen
- Überbelastungen

5. Promotive factors:

- Loads on unusual soils (underground)
- shortened calf musculature and/or hardened calf musculature
- bad or wrong footwear (too high or too rigid or with pressure of the rear edge of shoe on the Achilles' tendon)
- Fott deformity (e.g. hollow foot)
- changed leg statics (o or X-leg)
- Back problems within the range of the lumbar spine
- Problems within the range of the knee joints or the hip joint
- Metabolic illnesses (high cholesterol level, elevated urine acid values) can lead provoking to deposits within the range of the Achilles' tendon and may cause irritations.
- Rheumatism tables illnesses

6. Symptoms:

- Movement pain: The pain steps particularly when unreeling the foot on particularly in the morning after rising. The pain leaves after after some steps/becomes smaller, steps however immediately after a movement break.
- Sensitivity to pressure
- Swelling the sliding fabric around the Achilles tendon
- with the partial tear a course is still possible, while with complete tear the foot movements are still feasible hardly. The concerning has then a limping course picture or it is no more going possible.

7. First measures

- immediately reduce the load
- Cooling (do not put the ice directly on the skin)
- Federation put on, which relieves the Achilles' tendon (with/without ointment)
- immediately visit physician, to get exact diagnostic position

8. Diagnostics:

- clinical examination
- Depression within the range of the injury gropable (partial rupture and complete rupture)
- Difficulties the toe conditions or one-leg-toe-stand
- picture-giving procedures, like ultrasonic and roentgen (by means of the radiographical investigation bony participation can be excluded)
- Magnetic resonance imaging

9. Therapy:

depending upon severity level and age of the injury conservative or operational therapy
A) Conservative therapy
- Injections
- pain and anti-inflammatory medicine
- decongestant medicines with larger swelling/haematoma
- Immobilizing (with partial rupture as well as complete rupture) by appropriate shoe supply, in which itself are inserts for the discharge of the Achilles' tendon
- should be paid attention with Achilles' tendon complaints to shoes with as high an heel absorption as possible. The shoe must sit well at the foot and have the heel a good guidance and a firm stop. The rear edge of the shoe should not exert and also all too far up not hand pressure on the Achilles' tendon, around then when unreeling not to push the sliding fabric and/or the tendon.
- a gypsum treatment must in each case be avoided .

b) Operational therapy
- Tendon seam with cracks
- Tendon splitting, cutting degenerative portions, Anfrischung and seam out with catch of the tendon (= Achillodynie)

10. Physiotherapy:

- Manual mobilization
- Electro therapy
- Lymphdrainage
- Exercise practices
- leg axis stabilisation
- proprioceptive training
- stretching measures

11. Prevention:

Important here a good warming up program is to be accomplished before each sporty load. One should prepare the feet accordingly, and/or muscles and chords for the following load. Before a load brief stretching should take place, while after the load the stretch should be held during a longer period. On good footwear achten.

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