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What Are Principal Causes And Signs Of A Ruptured Achilles Tendon?



Overview
Achilles Tendon
The Achilles tendon runs from the calf muscles at the back of the lower leg and inserts at the back of the heel. A torn achilles can be a partial rupture or a total rupture. A total rupture is more common in men affecting them 10 times more than women. Injury typically occurs 30 to 40 minutes into a period of exercise rather than at the start of a session and nearly always happens from a sudden explosive movement or bending the foot upwards. Many patients are able to continue to function following an achilles rupture due to other muscles compensating although the injured leg will be significantly weaker. There are four key tests which can help diagnose a ruptured achilles tendon.

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 classic sign of an Achilles' tendon rupture is a short sharp pain in the Achilles' area, which is sometimes accompanied by a snapping sound as the tendon ruptures. The pain usually subsides relatively quickly into an aching sensation. Other signs that are likely to be present subsequent to a rupture are the inability to stand on tiptoe, inability to push the foot off the ground properly resulting in a flat footed walk. With complete tears it may be possible to feel the two ends of tendon where it has snapped, however swelling to the area may mean this is impossible.

Diagnosis
During the physical exam, your doctor will inspect your lower leg for tenderness and swelling. In many cases, doctors can feel a gap in your tendon if a complete rupture has occurred. The doctor may also ask you to kneel on a chair or lie on your stomach with your feet hanging over the end of the exam table. He or she may then squeeze your calf muscle to see if your foot will automatically flex. If it doesn't, you probably have ruptured your Achilles tendon. If there's a question about the extent of your Achilles tendon injury, whether it's completely or only partially ruptured, your doctor may order a magnetic resonance imaging (MRI) scan. This painless procedure uses radio waves and a strong magnetic field to create a computerized image of the tissues of your body.

Non Surgical Treatment
You may need to wear a plaster cast, brace or boot on your lower leg for six to eight weeks to help the tendon heal. During this time, your doctor will change the cast a number of times to make sure your tendon heals in the right way. If your tendon is partially ruptured, your doctor will probably advise you to have this treatment instead of surgery. It?s also suitable for people who aren't very physically active. However, there is a greater risk that your tendon will rupture again, compared with surgery. Your doctor will advise you which treatment is best for you.
Achilles Tendonitis

Surgical Treatment
Surgery for Achilles tendon rupture requires an operation to open the skin and physically suture (sew) the ends of the tendon back together, has a lower incidence of re-rupture than nonsurgical treatment. Allows return to pre-injury activities sooner and at a higher level of functioning with less shrinkage of muscle. Risks are associated with surgery, anesthesia, infection, skin breakdown, scarring, bleeding, accidental nerve injury, higher cost, and blood clots in the leg are possible after surgery. Surgery has been the treatment of choice for the competitive athlete or those with a high level of physical activity, for those with a delay in treatment or diagnosis, and for those whose tendons have ruptured again.

Prevention
You can help to reduce your risk of an injury to your Achilles tendon by doing the following. When you start a new exercise regime, gradually increase the intensity and the length of time you spend being active. Warm up your muscles before you exercise and cool them down after you have finished. The benefit of stretching before or after exercise is unproven. However, it may help to stretch your calf muscles, which will help to lengthen your Achilles tendon, before you exercise. Wear appropriate and well-fitting shoes when you exercise.