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Achilles tendon

From Wikipedia, the free encyclopedia
Not to be confused withAchilles' heel.
Achilles tendon
The Achilles tendon or calcaneal tendon is attached to the gastrocnemius and soleus muscles.
Details
LocationBack of the lowerleg
Identifiers
Latintendo calcaneus, tendo Achillis
MeSHD000125
TA98A04.7.02.048
TA22662
FMA51061
Anatomical terminology

TheAchilles tendonorheel cord,also known as thecalcaneal tendon,is atendonat the back of the lowerleg,and is the thickest in the human body.[1][2][3][4][5][6][excessive citations]It serves to attach theplantaris,gastrocnemius(calf) andsoleus musclesto thecalcaneus(heel) bone. These muscles, acting via the tendon, causeplantar flexionof the foot at theankle joint,and (except the soleus)flexionat theknee.

Abnormalities of the Achilles tendon include inflammation (Achilles tendinitis), degeneration,rupture,and becoming embedded with cholesterol deposits (xanthomas).

The Achilles tendon was named in 1693 after the Greek heroAchilles.[7]

History

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The oldest-known written record of the tendon being named forAchillesis in 1693 by the Flemish/Dutch anatomistPhilip Verheyen.In his widely used textCorporis Humani Anatomiahe described the tendon's location and said that it was commonly called "the cord of Achilles."[8][9]The tendon has been described as early as the time ofHippocrates,who described it as the "tendo magnus"(Latin for" great tendon ")[dubious–discuss]and by subsequent anatomists prior to Verheyen as "chorda Hippocratis"(Latin for" Hippocrates' string ").[9]

Verheyen referred to the mythological account of Achilles being held by the heel by his motherThetiswhen she dipped him in theRiver Styxas a baby to render his body invulnerable. As the heel by which she held him was not touched by the water, it was his one vulnerable spot (hence the expression "Achilles' heel") and he was eventually killed by a poison dart to the heel. The name thus also refers to the particularly disabling and painful effect of an injury to this tendon.[9]The first closed rupture was described byAmbroise Parein the sixteenth century.[9]

The Achilles tendon is also known as the "tendo calcaneus"(Latin for" calcaneal tendon ").[9]Becauseeponyms(names relating to people) have no relationship to the subject matter, most anatomical eponyms also have scientifically descriptive terms. The term calcaneal comes from the Latincalcaneum,meaning heel.

Structure

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The achilles tendon,tendo calcaneusattaches distally to the calcaneual tuberosity, and arises superiorly from the triceps surae complex of the gastrocnemius and soleus muscles.
Achilles tendon at foetus

The Achilles tendon connects muscle to bone, like othertendons,and is located at the back of the lower leg. The Achilles tendon connects thegastrocnemiusandsoleusmuscles to thecalcaneal tuberosityon thecalcaneus(heel bone).[10]The tendon begins near the middle of the calf, and receives muscle fibers on its inner surface, particularly from the soleus muscle, almost to its lower end. Gradually thinning below, it inserts into the middle part of the back of the calcaneus bone. The tendon spreads out somewhat at its lower end so that its narrowest part is about 4 cm (1.6 in) above its insertion.[11]

The tendon is covered by thefasciaand skin, and stands out prominently behind the bone; the gap is filled up withareolarandadipose tissue.Abursalies between the tendon and the upper part of the calcaneus. It is about 15 centimetres (6 in) long.

Along the side of the muscle, and superficial to it, is thesmall saphenous vein.Thesural nerveaccompanies the small saphenous vein as it descends in the posterior leg, traveling inferolateral to it as it crosses the lateral border of the Achilles tendon.[12]The tendon is the thickest tendon in the human body.[11]It can receive a load stress 3.9 times body weight during walking and 7.7 times body weight when running.[13]

The blood supply to the Achilles tendon is poor, and mostly via a recurrent branch of theposterior tibial artery,and some through arterial branches passing through surrounding muscles.[11]

Function

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Acting via the Achilles tendon, the gastrocnemius and soleus muscles causeplantar flexionof the foot at theankle.This action brings the sole of the foot closer to the back of the leg. The gastrocnemius alsoflexesthe leg at the knee. Both muscles are innervated by thetibial nerve.[14]Because the fibres of the tendon spiral about 90 degrees, fibres from the gastrocnemius tend to attach to the outer part of the bone, whereas fibres from the soleus tend to attach closer to the midline.[11]

Vibration of the tendon without vision has a major impact onposturalorientation.[15]Vibration of the tendon causes movement backwards and the illusion of a forward body tilt in standing subjects.[16]This is because vibrations stimulatemuscle spindlesin the calf muscles. The muscle spindles alert the brain that the body is moving forward, so thecentral nervous systemcompensates by moving the body backwards.

Clinical significance

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Inflammation

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Main article:Achilles tendinitis

Inflammationof the Achilles tendon is calledAchilles tendinitis.Achillestendinosisis the soreness or stiffness of the tendon, particularly worse when exercising, and generally due to overuse.[17]The most common symptoms are sharp achy pain and swelling around the affected tendon.[18][19][20]The pain is typically worse at the start of exercise and decreases thereafter.[21]Stiffness of the ankle may also be present.[17]Onset is generally gradual.[18]

It commonly occurs as a result of overuse such asrunning.[17][21]Other risk factors include trauma, a lifestyle that includes little exercise,high-heel shoes,rheumatoid arthritis,and medications of thefluoroquinoloneorsteroidclass.[18]Diagnosis is generally based on symptoms andexamination.[21]

Whilestretchingand exercises to strengthen the back are often recommended for prevention, evidence to support these measures is poor.[22][23][24]Treatment typically involves rest, ice,non-steroidal antiinflammatory agents(NSAIDs), andphysical therapy.[17][18]Aheel liftororthoticsmay also be helpful.[17][21]In those in who symptoms last more than six months despite other treatments, surgery may be considered.[17]Achilles tendinitis is relatively common.[17]

Degeneration

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Achilles tendon degeneration (tendinosis) is typically investigated with eitherMRIorultrasound.In both cases, the tendon is thickened, may demonstrate surrounding inflammation by virtue of the presence of paratenonitis, retrocalcaneal or retro-achillesbursitis.Within the tendon, increased blood flow, tendon fibril disorganisation, and partial thickness tears may be identified. Achilles tendinosis frequently involves the mid portion of the tendon but may involve the insertion, which is then known as enthesopathy. Thoughenthesopathymay be seen in the context of advancing age, it is also associated witharthritissuch asgoutand theseronegative spondyloarthritides.Achilles tendinosis is a known risk factor for calf muscle tears.[25]

Rupture

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Main article:Achilles tendon rupture

Achilles tendon ruptureis when the Achilles tendon breaks.[26]Symptoms include the sudden onset of sharp pain in theheel.[18]A snapping sound may be heard as the tendon breaks and walking becomes difficult.[27]

Rupture typically occurs as a result of a sudden bending up of the foot when the calf muscle is engaged, directtrauma,or long-standing tendonitis.[27][26]Other risk factors include the use offluoroquinolones,a significant change in exercise,rheumatoid arthritis,gout,orcorticosteroiduse.[28][26]Diagnosis is typically based on symptoms andexaminationand supported bymedical imaging.[26]Achilles tendon rupture occurs in about 1 per 10,000 people per year.[26]Males are more commonly affected than females.[28]People in their 30s to 50s are most commonly affected.[26]

Prevention may include stretching before activity.[27]Treatment may be by surgery orcastingwith the toes somewhatpointed down.[29][26]Relatively rapid return to weight bearing (within 4 weeks) appears okay.[29][30]The risk of re-rupture is about 25% with casting.[26]If appropriate treatment does not occur within 4 weeks of the injury outcomes are not as good.[31]

Xanthomas

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Tendon xanthomasare cholesterol deposits that commonly develop in the Achilles tendon of people with lipid metabolism disorders such asfamilial hypercholesterolemia.[32]

Neurological exam

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The Achilles tendon is often tested as part of aneurological examination.In this examination, the tendon is hit with atendon hammer.This tests the S1 and S2spinal nerves:a normal response isplantar flexion(downward movement) of the foot.[33]

Level or portion of tendon affected:[34]

  • Paratendinopathy:The inflammation of a connective tissue sleeve which surrounds the tendon and protects it from friction, irritation, and repeated trauma
  • Insertional:Eminently overuse-injury which frequently occurs in running and jumping athletes. Patients affected by insertional Achilles tendinopathy complain of pain on the posterior aspect of the heel and may have morning stiffness, swelling with activity and tenderness at the tendon insertion level.[35]If this condition becomes chronic, calcific deposits at the Achilles insertional level may be developed (due to microfractures and healing of the osteotendinous union) which can degenerate, if it persists over time, in the abnormal bony prominence on the posterior aspect of heel, condition known as Haglund deformity,[36]which can be painful and difficult close-shoes fitting due to friction and irritation.
  • Mid-portion:Occurs approximately 2–7 cm proximal from the Achilles insertion[37]into the calcaneus. Characterized by a combination of pain and swelling at this level. It has associated a remarkable impaired performance.

Other animals

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The Achilles tendon is short or absent ingreat apes,but long in arborealgibbonsand humans.[38]It provides elastic energy storage in hopping,[39]walking, and running.[38]Computer models suggest this energy storage Achilles tendon increases top running speed by >80% and reduces running costs by more than three-quarters.[38]It has been suggested that the "absence of a well-developed Achilles tendon in the nonhuman African apes would preclude them from effective running, both at high speeds and over extended distances."[38]

See also

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References

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  2. ^Richardson TG (1854).Elements of human anatomy: general, descriptive, and practical.Lippincott, Grambo, and Co. pp.441–.
  3. ^McGlamry ED, Banks AS (1 June 2001).McGlamry's comprehensive textbook of foot and ankle surgery.Lippincott Williams & Wilkins.ISBN978-0-683-30471-8.
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  5. ^Voermans NC, Huijing PA (February 2013)."Fascia-related disorders: Hypermobility.".In Schleip R, Findley TW, Chaitow L, Huijing P (eds.).Fascia: The Tensional Network of the Human Body: The science and clinical applications in manual and movement therapy.Elsevier Health Sciences. pp. 218–.ISBN978-0-7020-5228-6.
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  7. ^Taylor RB (2017).The Amazing Language of Medicine: Understanding Medical Terms and Their Backstories.Springer. p. 2.ISBN9783319503288.
  8. ^Veheyen P(1693),Corporis humani anatomia,Leuven: Aegidium Denique, p. 269,retrieved12 March2018,Vocatum passimchorda Achillis,& ab Hippocratetendo magnus.(Appendix, caput XII.De musculis pedii et antipedii,p. 269)
  9. ^abcdeKlenerman L (April 2007)."The early history of tendo Achillis and its rupture".The Journal of Bone and Joint Surgery. British Volume.89(4): 545–547.doi:10.1302/0301-620X.89B4.18978.PMID17463129.
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  16. ^Ceyte H, Cian C, Zory R, Barraud PA, Roux A, Guerraz M (April 2007). "Effect of Achilles tendon vibration on postural orientation".Neuroscience Letters.416(1): 71–75.doi:10.1016/j.neulet.2007.01.044.PMID17300868.S2CID24715489.
  17. ^abcdefgConyer RT, Beahrs T, Kadakia AR (March 2022)."Achilles Tendinitis".OrthoInfo.Retrieved4 July2018.
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  30. ^van der Eng DM, Schepers T, Goslings JC, Schep NW (2012). "Rerupture rate after early weightbearing in operative versus conservative treatment of Achilles tendon ruptures: a meta-analysis".The Journal of Foot and Ankle Surgery.52(5): 622–628.doi:10.1053/j.jfas.2013.03.027.PMID23659914.
  31. ^Maffulli N, Ajis A (June 2008). "Management of chronic ruptures of the Achilles tendon".The Journal of Bone and Joint Surgery. American Volume.90(6): 1348–1360.doi:10.2106/JBJS.G.01241.PMID18519331.
  32. ^Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J (2012).Harrison's Principles of Internal Medicine(18th ed.). New York: McGraw-Hill. p. 3149.ISBN978-0071748896.
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  34. ^Sardon Melo SN (28 August 2018)."Achilles tendinopathy".Emirates Integra.Archived fromthe originalon 4 November 2018.Retrieved20 October2020.
  35. ^Weinfeld SB (March 2014). "Achilles tendon disorders".The Medical Clinics of North America.98(2): 331–338.doi:10.1016/j.mcna.2013.11.005.PMID24559878.
  36. ^Sundararajan PP, Wilde TS (March 2014). "Radiographic, clinical, and magnetic resonance imaging analysis of insertional Achilles tendinopathy".The Journal of Foot and Ankle Surgery.53(2): 147–151.doi:10.1053/j.jfas.2013.12.009.PMID24556480.
  37. ^Wiegerinck JI, Kerkhoffs GM, van Sterkenburg MN, Sierevelt IN, van Dijk CN (June 2013). "Treatment for insertional Achilles tendinopathy: a systematic review".Knee Surgery, Sports Traumatology, Arthroscopy.21(6): 1345–1355.doi:10.1007/s00167-012-2219-8.PMID23052113.S2CID2214735.
  38. ^abcdSellers WI, Pataky TC, Caravaggi P, Crompton RH (2010). "Evolutionary Robotic Approaches in Primate Gait Analysis".Int J Primatol.31(2): 321–338.doi:10.1007/s10764-010-9396-4.S2CID30997461.
  39. ^Lichtwark GA, Wilson AM (December 2005)."In vivo mechanical properties of the human Achilles tendon during one-legged hopping".The Journal of Experimental Biology.208(Pt 24): 4715–4725.doi:10.1242/jeb.01950.PMID16326953.
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