A: The Achilles tendon is the hard rope like tendon at the back of the ankle. It is responsible for transmitting the force of the calf muscles (gastrocnemius and soleus) to the ankle to allow movements of the foot such as standing on your toes or standing on your heals.
BORING HISTORICAL TRIVIA. The name Achilles tendon comes from Greek mythology. The brief synopsis is that the warrior Achilles, was dipped into the river Styx shortly after birth by his mother to 'toughen him up'. Unfortunately, she had to hold him somewhere-choosing the back of the heel. So, Achilles heels were his week spot, and he was shot there with and arrow and died.
Anyways, the Achilles tendon for us mere mortals can still be a source of trouble. Because the Achilles tendon is attached to a muscle which crosses two joints (knee + ankle), it can be exposed to considerable stress during walking/running/jumping/pivoting etc. Too much stress, and the tendon can snap (OW!!).
Q: Which sporting activities are most likely to lead to rupture of the Achilles tendon ?
A: Although any sport that involves walking or running can lead to damage to the Achilles tendon, some sports are particularly evil culprits. In general, sport that involve hard cutting movements such as badminton, soccer, gymnastics, or volleyball are most likely to lead to Achilles damage. Nonetheless, tendon ruptures occur during normal daily activities in a large proportion of victims.
Q: Which is the best treatment option for Achilles tendon rupture: surgery or conservative management such as casting and physiotherapy ?
A: Opinions have always differed among orthopedic surgeons as to whether surgical or conservative management is best for Achilles tendon rupture.
Surgical treatment usually involves simply suturing the two ends of the tendon back together. This can be done under general anesthetic, or simply local freezing. Following the surgery a cast is usually required, this prevents the newly repaired area from being stressed before healing has taken place.
When conservative management is employed, it usually involves the same type of cast. This is often placed with the ankle in plantar flexion (like standing on your toes) to bring the two ends of the tendon close together and allow them to re-heal back to one another. Plan on wearing the cast for about 6-8 weeks.
Following the casting, with or without surgery, a careful period of physiotherapy and progressive re-introduction to sports is planned in order to minimize re-tearing of the tendon
A recent large study of 111 patients concluded that surgical treatment-with end to end anastomosis (joining) of the tendon was preferable to the non-surgical treatment. In general, surgical treatment results in a better rate of return to previous sport activities, better ankle movement, and fewer cases of calf atrophy (shrinking of the calf muscles due to lack of activity).
In this study, there was no statistically significant difference in re-rupture rates among surgical versus non-surgical patients. When reviewing other literature, 4597 cases, a small difference in re-rupture rates does exist: 1.4% chance of re-rupture following surgical treatment versus 13.4% chance of re-rupture in the non-surgical group.
In the end, the authors conclude that while non-surgical treatment is acceptable, surgical treatment is probably preferable.