Diagnosis and Treatment of Achilles Tendon Injury

Rongbin Wang

Guangzhou Foreign Language School, Guangzhou, China

Keywords: Achilles Tendon Injury, Diagnostic Imaging, Surgical Treatment.

Abstract: The Achilles tendon is the thickest and strongest tendon in the human body, and due to its unique anatomical

location and physiological function, it is also one of the most prone tendons to rupture. With the development

of biomechanics research in recent years, more biomechanical concepts and research methods have been

incorporated into the etiology analysis of Achilles tendon injuries, especially Achilles tendon ruptures. This

study suggests that Achilles tendon injury has become a potential threat for athletes in track and field as well

as ball sports during running and jumping. The probability of Achilles tendon injury varies depending on the

sports they participate in and their grade level. Senior college students engaged in jumping and competitive

sports have a higher probability of developing Achilles tendon injury. Achilles tendon injury is one of the

most common symptoms in orthopedic clinical practice, and there are many causes of Achilles tendon injury,

with the highest number of cases of accidental injury to the Achilles tendon due to improper exercise. The

treatment of chronic Achilles tendinitis in Achilles tendon injury is relatively simple, and the treatment

methods are also relatively single. The treatment of Achilles tendon rupture is mainly divided into

conservative and surgical methods, including surgical treatment, conservative treatment, rehabilitation

treatment, and cytokine action.

1 INTRODUCTION

The Achilles tendon is the most powerful and thickest

tendon in a human body, located behind the ankle

joint. Its starting point is one-third of the lower back

of the calf, and its endpoint is the calcaneal

tuberosity. Therefore, it can transfer strength to the

feet by pulling the muscles of the posterior calf

muscle group, and its main physiological function is

to help the plantar flexion of the foot and ankle joint.

Common Achilles tendon injuries are mainly divided

into acute and chronic injuries, and diseases mainly

include Achilles tendon rupture and Achilles

tendinitis. The Achilles tendon is one of the most

easily breakable tendons in the human body, mainly

due to its unique physiological function and

anatomical location. Once Achilles tendon injury

occurs, the quality of life of patients will be greatly

affected.

The blood supply of Achilles tendon is mainly

provided by branches of the posterior tibial artery,

followed by branches of the fibular artery. The

vascular distribution is relatively sparse 2-6 cm above

the insertion point, which is prone to ischemic

degeneration of the tendon structure. Tearing and

rupture of the Achilles tendon often occur in this

segment. The microvessels and capillaries in the

upper, middle, and lower segments of the Achilles

tendon are not evenly distributed, with significantly

fewer in the middle segment than in the upper and

lower segments. This may be the pathological

anatomical basis for the frequent occurrence of

Achilles tendon rupture in the middle segment.

According to the epidemiology, in recent years, with

the progress of people's living standards and

lifestyles, the awareness of sports has gradually

increased, and the incidence rate of acute has also

gradually increased. The incidence rate of male

patients is higher than that of female patients, mainly

aged 35-39 years (Lantto et al.,2015).

2 DIAGNOSIS

The known risk factors for Achilles tendon injury

include previous intratendinopathy, history of

fluoroquinolone use, history of steroid injection, and

history of inflammatory arthritis (Haapasalo et al.,

2018). With the development of biomechanics

research in recent years, more biomechanical

concepts and research methods have been

incorporated into the etiology analysis of Achilles

Wang, R.

Diagnosis and Treatment of Achilles Tendon Injury.

DOI: 10.5220/0014494900004933

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 1st International Conference on Biomedical Engineering and Food Science (BEFS 2025), pages 439-443

ISBN: 978-989-758-789-4

439

tendon injury, especially Achilles tendon rupture.

Which is subjected to dynamic loads at or near failure

during movement, and fatigue induced damage may

be a factor leading to its ultimate fatigue and failure

(Noback et al., 2018).

The diagnostic method for Achilles tendon injury

is supported by clinical manifestations and imaging

and ultrasound examination results. Imaging mainly

relies on X-rays and MRI. In recent years, progress in

the diagnosis of Achilles tendon injury has mainly

been made through the update of imaging and

ultrasound equipment, as well as new research and

exploration by doctors based on new diagnostic

equipment. A clinical trial has shown that high-

frequency ultrasound has high diagnostic sensitivity

and specificity for Achilles tendon. Elastic ultrasound

imaging technology can accurately reflect muscle

tension and assess muscle strength in patients with

acute Achilles tendon injury. At the same time, there

is a linear correlation between the longitudinal tensile

force borne by the tendon and the elastic modulus

value measured by elastic ultrasound imaging

technology, which can reflect the elasticity of the

Achilles tendon and achieve effective diagnosis of the

patient's disease.

MRI has the characteristics of multi plane

imaging and high soft tissue resolution, which can

well display the morphology and signal changes of

Achilles tendon, determine the location and degree of

tear, and also display the changes in surrounding soft

tissue structure. It can comprehensively and

accurately evaluate Achilles tendon tear and is the

preferred imaging examination method for acute

Achilles tendon tear. The normal Achilles tendon

shows low signal shadows on both T1WI and T2WI

sequences, and there may be strip like high signal

shadows inside. The strip like high signal shadows

are parallel to Achilles tendon and have a width of

less than 1.5mm. When the magic angle phenomenon

occurs (the main magnetic field forms a 55 ° angle

with the normal tendon diameter), the phenomenon in

the magic angle rarely occurs in the conventional

position. If the ruptured tendon bends, the effect of

magic angle may occur, which needs to be analyzed

comprehensively (Peh and Chan, 1998).

The MRI manifestations of complete Achilles

tendon tear include retraction of the rupture end, and

the width of the rupture crack reflects the degree of

retraction of both ends. The ruptured fibrous bundles

interlock and overlap with each other in a "brush"

shape, and the ruptured fibrous bundles retract in a

"oak" shape. When the torn tendon retracts

significantly, it can appear wavy. MRI manifestations

of incomplete Achilles tendon tear: Partial Achilles

tendon tear, with a stripe like, patchy, and focal high

signal shadow at the tear site compared to normal

Achilles tendon. Incomplete Achilles tendon tear

shows continuity on at least one level. Partial

incomplete tearing occurs on the basis of certain

lesions, as shown in Figures 1 (Xiao et al., 2014).

Figure 1: MRI manifestations of incomplete Achilles

tendon tear.

3 ACHILLES TENDON INJURY

AND MOTOR FUNCTION

Achilles tendon injury has become a potential threat

for athletes in athletics and ball sports during running

and jumping. Previous literature studies have

reported that runners should be aware of the overuse

injuries which is on the tendon, and athletes engaged

in athletics and ball sports should pay attention to

Achilles tendinopathy. Epidemiological data shows

that in the past few decades, the incidence that about

the Achilles tendon rupture has increased from

11/100000 to 37/100000, and the incidence is still on

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440

the rise. More than 60% of tendon ruptures are related

to participating during in the sports. Therefore, in the

field of sports medicine, sports researchers should

pay special attention to and attach importance to the

issue of Achilles tendon injuries in athletes engaged

in athletics and ball sports during training and

competition.

The probability of Achilles tendon injury varies

depending on the sports program and grade level.

Senior college students who engage in jumping and

competitive sports have a higher probability of

Achilles tendon injury. In relevant research literature,

Leppilahti et al.(1996) believe that continuous jump

movements, strides, and single foot landing

movements in basketball, as well as forward strides,

large forward strides, light jump forward strides, and

light jump backward movements in badminton, are

more likely to cause Achilles tendon injury, even

tearing (or rupture), compared to other sports.

Numerous studies have shown that there are

significant differences between conservative

treatment and surgical treatment in terms of recovery

time, treatment efficacy, and recurrence rate. It can be

seen that conservative treatment can achieve good

therapeutic effects in patients with chronic Achilles

tendon injury and partial tear injury under certain

circumstances. However, compared with surgical

treatment, there are still disadvantages such as

difficult healing and high recurrence rate in some

patients.

The Achilles tendon in the human body shows the

largest tendon group, and its importance to the body

is self-evident. Its proximal end refers to the muscle

belly of the soleus muscles, and its distal end extends

to the calcaneal tuberosity. Its main function is to

maintain the stability of the ankle joint when

standing, prevent the body from tilting forward, and

assist in completing movements such as walking,

jumping, and running, playing a key role in the body's

load-bearing capacity. Under normal circumstances,

the force on the tendon bone complex in the human

body is uniform and consistent. However, during

intense exercise, the position of force on the entire

foot changes significantly, resulting in a decrease in

the contraction and coordination ability of the active

muscles, which in turn leads to an imbalance in the

weight-bearing capacity of the tendon bone complex,

causing damage to the weak area of the Achilles

tendon or increasing its risk of injury. The injury is

one of the most common symptoms in orthopedic

clinical practice, and there are many causes of

Achilles tendon injury, with the highest number of

cases of accidental injury to the Achilles tendon due

to improper exercise.

In real life, there are two mechanisms that may

cause injury to patients. One is due to long-term long-

distance jumping exercise, which can lead to

degenerative changes in the tendon and ultimately

trigger Achilles tendon injury. The injury caused by

this reason is closed and the surface skin of the

affected area is not affected; Another type of injury is

caused by sharp cutting or direct impact, and in

severe cases, it can even lead to Achilles tendon

rupture, which belongs to open type. Patients with

closed Achilles tendon injuries often suffer from

injuries caused by the inability to bear weight at the

moment when the limb suddenly jumps and the toe is

close to the ground. It is necessary to treat the affected

limb with congestion, swelling elimination, and pain

management to prevent infection. At the same time,

patients should be guided to undergo proper

rehabilitation training to ensure a speedy recovery.

4 TREATMENT

The treatment in Achilles tendon injury is relatively

simple, and the treatment methods are also relatively

single. The treatment is mainly divided into two

treatment methods: conservative and surgical. There

is no unified understanding in medicine regarding the

choice of the two treatment methods, but surgical

treatment is still the main means for orthopedic

surgeons to treat Achilles tendon rupture or defect. In

recent years, the development of surgical methods

has mainly focused on minimally invasive techniques

and the improvement and research of existing

technologies. This also requires clinicians and family

members to consider comprehensively and make

accurate judgments when choosing treatment

methods. The basis for accurate judgment is not only

the patient's symptoms and examination results, but

also the patient's prognosis and the acceptance of the

prognosis by the patient and family members.

Therefore, patients should be fully informed of the

advantages and disadvantages of the two treatment

methods before treatment, and the final decision

between surgical or non-surgical treatment should be

based on the joint decision-making and specific

factors from the patient.

4.1 Surgical Treatment

The surgical treatment in the injury about Achilles

tendon mainly involves the treatment in the rupture

or defect. Currently, there are two main methods:

open and minimally invasive surgery. Minimally

invasive treatment is currently the preferred choice to

Diagnosis and Treatment of Achilles Tendon Injury

441

avoid postoperative complications as much as

possible. For example, arthroscopic percutaneous

anastomosis technology and Achilles tendon

anastomosis devices are used in the treatment, but

they have a clear range of applications and are more

suitable for patients with clear preoperative

examination results and small Achilles tendon

rupture or defect area. In the study of postoperative

infection incidence, a meta-analysis including 5

RCTs and 4 cohort studies showed that the deep

infection rate of minimally invasive treatment was

significantly lower than that of open treatment (Yang

et al., 2017).

Open surgery is a relatively traditional surgical

method, including V-Y tendon reconstruction,

gastrocnemius fascia flap, tendon transplantation,

allogeneic transplantation reconstruction, autograft

reconstruction, artificial transplantation

enhancement, and biomaterial enhancement. In

recent years, there have been many studies on clinical

doctors using open surgery for Achilles tendon repair.

V-Y tendon reconstruction is an effective and

economical method in classic surgery, suitable for

large and medium-sized (2 cm or more) defects. A

mid - to long-term follow-up study on the

reconstruction using V-Y tenoplasty showed that it

can produce satisfactory functional outcomes and

lower incidence of complications, without the need

for expensive synthetic implants (Lin et al., 2019).

4.2 Conservative Treatment

In terms of conservative treatment, traditional

conservative treatment requires 6-8 weeks of plaster

fixation. Within the first 4 weeks, place the ankle in a

cast which in a plantar flexion position, and then

place it in a neutral position for the next 2-4 weeks.

The cast provides protection for the tendon during the

maximum treatment in healing, but fixation may

increase the risk of calf muscle atrophy, gait

abnormalities, and thrombosis (Healy et al., 2010). In

recent years, functional braces have been involved in

conservative treatment of Achilles tendon injuries.

The calf in a patient is placed in a removable walking

boot that includes wedges for lifting the heel.

Compared with surgical treatment, a long-term

research showed that patients who use functional

braces have longer underground time and healing

cycle than those who use surgical sutures, making

them more suitable for patients with severe

comorbidities and less lifestyle exercise.

4.3 Rehabilitation Treatment

After long-term follow-up studies at multiple centers,

it has been found that rehabilitation therapy, whether

surgical or conservative, has a significant impact on

the prognosis of patients by helping to strengthen

muscle strength and improve ankle joint mobility

(Westin et al., 2018). The first is to prevent

complications. The highest incidence rate of

complications after Achilles tendon surgery is deep

vein thrombosis. The latest research found that deep

vein thrombosis will affect the prognosis of patients

with Achilles tendon injury through their subjective

and functional factors (Svedman et al., 2020).

Intermittent pneumatic compression during the

rehabilitation period of Achilles tendon injury and leg

fixation has been shown to reduce the risk. At the

same time, studies have shown that intermittent

initiation of compression may promote the growth of

Achilles tendon ends by upregulating the synthesis of

type I collagen. Secondly, it can promote functional

recovery. A prospective cohort study found that

immediate weight-bearing and early functional

activity of the ankle joint during the early healing

period after surgery can better restore patients'

function and muscle strength compared to fixation in

a plaster model for the first 2 weeks (Aufwerber et al.,

2020).

4.4 Cytokine Effects

There are two mechanisms of healing after Achilles

tendon injury, one is endogenous healing and the

other is exogenous healing. The Exogenous healing

mainly relies on fibrous connective’s growth, which

is tissued into the Achilles tendon, accompanied by

fibrous adhesions. Endogenous healing refers to the

division and proliferation of fibroblasts, including in

the tendon itself, blood vessels during the healing

process, or outer membrane of the tendon. The

normal tendon collagen fibers are formed through

self-cell proliferation and participate in the repair

process. Therefore, the increasing of the endogenous

healing can reduce the occurrence of adhesions

(Boyer et al., 2005). How to increase endogenous

healing of tendons, reduce exogenous healing of

tendons, and thereby reduce tendon adhesion and the

regulatory mechanism of endogenous healing of

tendons has been a hot topic in scientific research in

recent years.

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442

5 CONCLUSION

As the thickest and most powerful tendon in the

human body, the Achilles tendon located behind the

ankle joint is one of the most prone tendons to

rupture. Once Achilles tendon injury occurs, it will

have a huge impact on the patient's quality of life. In

the analysis of the etiology of Achilles tendon injury,

especially Achilles tendon rupture, it is necessary to

incorporate the concept and research methods of

biomechanics. The conclusion of this study is that the

diagnosis of Achilles tendon injury is mainly based

on the update of imaging and ultrasound equipment,

as well as new research and exploration conducted by

doctors on the basis of new diagnostic equipment.

The probability of Achilles tendon injury is related to

the sports they engage in and different grades. Senior

college students who engage in jumping and

competitive sports have a higher probability of

Achilles tendon injury. There are many reasons that

can cause Achilles tendon injury, and improper

exercise has the highest number of cases of accidental

injury to the Achilles tendon. In real life, there are

two mechanisms that can cause injury to patients: one

is due to long-term long-distance running and

jumping exercise, which leads to degenerative

changes in the Achilles tendon, and the other is due

to injury caused by sharp cutting or direct impact. The

treatment of Achilles tendon rupture is mainly

divided into two methods: conservative and surgical.

Before treatment, patients should be fully informed

of the advantages and disadvantages of both

treatment methods, and the final decision should be

based on the patient's specific factors and joint

decision-making. In short, in the field of sports

medicine, special attention and importance should be

paid to the issue of Achilles tendon injuries in athletes

engaged in athletics and ball sports during training

and competition, and continuous research and

improvement of treatment methods and effects for

Achilles tendon injuries should be carried out.

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