It primarily owes its name to the hero of the Iliad, Achilles, and, secondly, to the Dutch anatomist Philip Verheyen who “baptised” and described it for the first time in 1693, in his work “Corporis Humani Anatomia”. We are talking about the achilles tendon, which serves to attach the plantaris, gastrocnemius and soleus muscles to the heel.
A tendon rupture means that it is torn, and it no longer works properly as it can not correctly connect the muscles to the bones of the sole. The most common injury mechanism is for a tractive force to be abruptly applied. Ruptures usually occurs at 3-5 cm of the insertion of the Achilles tendon in the heel, centrally, in a region with poor vasculature.

Although it is the strongest tendon since it can withstand forces that reach 6 to 8 times the weight of the body during running and jumping, its rupture is a relatively common injury, especially in young people who practice sports, and, in the last decades, in active people, aged 30-50. Every year, in the US alone, orthopaedists are called upon to treat about 230,000 cases of Achilles tendon ruptures, and the numbers keep rising.
It is estimated that 75-80% of the injuries occur during sporting activities; in older ages, and especially in males who do not practice sports regularly (they are called the “weekend athletes” in the literature), it is an injury attributed to improper warm-up and overzealousness during high-demand sports.
In addition, studies have blamed, among others, chronic tendonitis, overuse of corticosteroids and anabolic steroids, the use of antibiotics containing fluoroquinolone, gout, hyperthyroidism, tendon overuse and degeneration, and changes in the foot mechanics.

Patients report a snapping sound, the sudden onset of pain, and most people describe that they felt like they were hit by a hammer at the back of the foot. Pain is accompanied by swelling and a haematoma, the walking ability significantly decreases, while, during the clinical examination, through which diagnosis is made, the orthopaedist can palpate the void which is generated along the tendon.
An ultrasonography and an MRI shall indicate the exact site of the lesion and shall reveal any incomplete ruptures. The lateral projection of a foot x-ray, if necessary, shall show if there is an avulsion fracture.

Treatment of an acute Achilles tendon rupture is usually surgical - conservative treatment, through the immobilization of the affected extremity for 7-9 weeks is only selected for high-risk or low functioning patients. During surgery, the tendon is sutured, with or without its reinforcement with a graft obtained by the patient themselves.
The Minimally Invasive Surgery (MIS) techniques applied over the past few years, in addition to the positive recovery effects, minimise the chances of a new rupture in the future and obliterate the complications of an open surgery. The surgeon avoids the large classic incisions of the skin as they perform closure through small holes, using a surgical microscope or even without it. Post-operative mobilisation is almost immediate, and postoperative pain is clearly reduced. The patient shall have to wear a special ankle stabilisation splint and follows a specific strengthening exercises programme and physiotherapies. 

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