Cipro Achilles Tendon Rupture Treatments

posted on 06 May 2015 20:24 by julie8pacheco13
Overview
Achilles Tendonitis The largest tendon in the body, the Achilles tendon is a cord connecting the calf muscles to the heel bone. Also called the ?cord of Achilles,? the tendon gets its name from the hero of Greek myth. According to legend, Achilles was invulnerable everywhere but his heel, where a poisoned arrow eventually felled him. Because the blood supply to the Achilles tendon lessens with age, the tendon becomes vulnerable to inflammation and rupture, a fact which makes it a true ?Achilles heel? for many older patients. Achilles tendon injuries are also common among athletes and those who engage in more physically demanding activity.

Causes
The Achilles tendon is a strong bands of fibrous connective tissue that attaches the calf muscle to the heel bone. When the muscle contracts, the tendon transmits the power of this contraction to the heel bone, producing movement. The Achilles tendon ruptures because the load applied to it is greater than the tendon's ability to withstand that load. This usually occurs as a result of a sudden, quick movement where there is a forceful stretch of the tendon or a contraction of the muscles eg: jumping, sprinting, or pushing off to serve in tennis. This occurs most often in sports that require a lot of stopping and starting (acceleration-deceleration sports) such as tennis, basketball, netball and squash. The Achilles tendon is on average 15cm in length. Most ruptures occur 2-6cm above where the tendon inserts into the heel bone. This is the narrowest portion of the Achilles tendon and is also the area with the poorest blood supply. achilles tendon rupture is most common when the muscles and tendon have not been adequately stretched and warmed up prior to exercise, or when the muscles are fatigued. the Achilles tendon has a poor blood supply, which makes it susceptible to injury and slow to heal after injury. During exercise the amount of blood able to travel to the tendon is decreased, further increasing the risk of rupture. Most experts agree that there are no warning signs of an impending rupture. However, frequent episodes of Achilles tendonitis (tendon inflammation) can weaken the tendon and make it more susceptible to rupture.

Symptoms
The most common initial symptom of Achilles tendon rupture is a sudden snap at the back of the heels with intense pain. Immediately after the rupture, the majority of individuals will have difficult walking. Some individuals may have had previous complains of calf or heel pain, suggesting prior tendon inflammation or irritation. Immediately after an Achilles tendon rupture, most individuals will develop a limp. In addition, when the ankle is moved, the patient will complain of pain. In all cases, the affected ankle will have no strength. Once the Achilles tendon is ruptured, the individual will not be able to run, climb up the stairs, or stand on his toes. The ruptured Achilles tendon prevents the power from the calf muscles to move the heel. Whenever the diagnosis is missed, the recovery is often prolonged. Bruising and swelling around the calf and ankle occur. Achilles tendon rupture is frequent in elderly individuals who have a sedentary lifestyle and suddenly become active. In these individuals, the tendon is not strong and the muscles are deconditioned, making recovery more difficult. Achilles tendon rupture has been reported after injection of corticosteroids around the heel bone or attachment of the tendon. The fluoroquinolone class of antibiotics (such as ciprofloxacin [Cipro]) is also known to cause Achilles tendon weakness and rupture, especially in young children. Some individuals have had a prior tendon rupture that was managed conservatively. In such cases, recurrence of rupture is very high.

Diagnosis
It is usually possible to detect a complete rupture of the Achilles tendon on the history and examination. A gap may be felt in the tendon, usually 4-5cm above the heel bone. This is the normal site of injury and is called an intra-substance tear. The tear can occur higher up about 10cm above the insertion into the heel at the site where the muscles join the tendon, this is known as a musculo-tendinous tear. A special test will be performed which involves squeezing the calf. Normally if the Achilles tendon is intact this causes the foot to point downwards but if it is ruptured it causes no movement. To confirm the diagnosis and the exact site of the rupture it may be necessary to perform an Ultra-sound or MRI scan.

Non Surgical Treatment
There are two treatment options available which are non-operative and operative. Non-operative treatment involves the use initially of a below-knee plaster with the foot held fully bent downwards. This usually stays in place for 2 weeks then is changed for a brace(this is a boot from the knee down to the toes with Velcro straps) which should be worn day and night. The brace will be regularly altered to allow the foot to come up to a more neutral position. The brace will be on for a further 6 weeks. After the 8 weeks you will be referred for physiotherapy to regain movement and calf strength but will probably need to wear the brace during the day for a further 4 weeks. Non-operative treatment avoids the risks of surgery but the risk of the tendon re-rupturing, which normally occurs within 3 months of discarding the brace, is 10%. Achilles Tendinitis

Surgical Treatment
Surgery is a common treatment for a complete rupture of the Achilles tendon. The procedure generally involves making an incision in the back of your lower leg and stitching the torn tendon together. Depending on the condition of the torn tissue, the repair may be reinforced with other tendons. Surgical complications can include infection and nerve damage. Infection rates are reduced in surgeries that employ smaller incisions. After treatment, whether surgical or nonsurgical, you'll go through a rehabilitation program involving physical therapy exercises to strengthen your leg muscles and Achilles tendon. Most people return to their former level of activity within four to six months.