Achilles tendon rupture

Japanese: アキレス腱断裂 - アキレスけんだんれつ（英語表記）Achilles tendon rupture

What kind of injury?

The Achilles tendon Triceps surae ( Hard money ) (calf muscle) tendon part Calcaneus ( Gift ) It is attached to the heel bone and acts to bend the ankle toward the plantar surface of the foot.

Achilles tendon ruptures are most often caused by a strong contraction of the triceps surae muscle. Direct ( Quick walk ) Rupture can also be caused by external force (direct external force) or hyperextension (overstretching).

How symptoms manifest

This often occurs when athletes in their 20s or people over 40 suddenly start playing sports, especially when stepping forward or landing after a jump, and there may be a "crack" sound when the ankle is torn. Even if the ankle is torn, it is possible to walk and plantar flex the ankle (bend the ankle toward the bottom of the foot), but it is not possible to stand on tiptoes.

Testing and diagnosis

The tendon may be seen or palpable through the skin where it has been torn. knees ( Knee ) If you bend your knee at a right angle and grab your calf, your ankle will plantar flex if it is healthy, but if your Achilles tendon is ruptured, it will not plantar flex at all (Thompson test). Diagnostic imaging is not always necessary, but ultrasound, MRI, soft x-rays, etc. may be used.

Treatment methods

There are conservative and surgical treatments. In conservative treatment, a plaster cast is applied and then a brace is used. In surgical treatment, the tendon is sutured and then a plaster cast is applied. There are methods that use a brace after that and methods that do not.

The re-rupture rate after surgery is 1.7-2.8%, while conservative treatment is 10.7-20.8%. Many people believe that surgical treatment has a lower risk of re-rupture and allows for a quicker return to work, so athletes often choose surgical treatment.

However, since complications such as infection and skin suture failure are not impossible, some facilities have recently begun to incorporate various innovations into conservative treatment to enable early recovery and expand the treatment to athletes as well.

What are the first aid and preventive measures?

As a first aid measure, Subcutaneous hematoma ( Hikkashush ) Use ice or ankle warmers to relieve pain. External fixation ( Foreigner ) It is not necessary to visit an orthopedic surgeon on the day of the injury, but you should visit an orthopedic surgeon as soon as possible. As a preventative measure, be sure to stretch and warm up thoroughly before playing sports.

Prince Kato

Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia

Japanese:

どんな外傷か

　アキレス腱は下腿三頭筋(かたいさんとうきん)（ふくらはぎの筋肉）の腱部分で踵骨(しょうこつ)というかかとの骨に付着しており、足首を足底側に曲げるはたらきをします。

　アキレス腱断裂は下腿三頭筋が強く収縮することによって発生することがほとんどですが、直達(ちょくたつ)外力（直接加わった外部からの力）や過伸展（伸ばしすぎ）による断裂もあります。

症状の現れ方

　20代のスポーツ選手や40歳以上の人が急にスポーツをした場合に、とくに踏み込み動作やジャンプの着地などで発生することが多く、断裂時に「バチッ」という音がすることもあります。断裂していても、歩行や足首を底屈する（足底側に曲げる）ことは可能ですが、つま先立ちをすることはできません。

検査と診断

　皮膚の上から断裂した部分に腱の陥凹が見られたり、触れることができます。うつ伏せに寝たまま膝(ひざ)を直角に曲げた状態でふくらはぎをわしづかみにすると健常であれば足首が底屈しますが、アキレス腱断裂があるとまったく底屈しません（トンプソンテスト）。画像診断は必ずしも必要ではありませんが、超音波やMRI、X線軟線撮影などが行われます。