関: Achilles tendon、tendo achillis

WordNet

manage or run; "tend a store"
have a tendency or disposition to do or be something; be inclined; "She tends to be nervous before her lectures"; "These dresses run small"; "He inclined to corpulence" (同)be given, lean, incline, run
have care of or look after; "She tends to the children"
a cord or band of inelastic tissue connecting a muscle with its bony attachment (同)sinew
relating to the heel bone or heel

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〈人が〉(…の)『傾向がある』,(…)しがちである / 〈物事が〉(ある方向に)向かう,(ある状態に)向かう
〈人・動植物など〉‘の'『世話をする』,めんどうをみる / 《米》〈店〉‘の'番をする / 《tend to+名》…に気をつける,心を配る
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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/01/19 21:16:32」(JST)

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The Achilles tendon or heel cord, also known as the calcaneal tendon or the tendo calcanei, is a tendon of the back of the leg. It serves to attach the plantaris, gastrocnemius (calf) and soleus muscles to the calcaneus (heel) bone.

The tendon is the thickest tendon in the human body. These two muscles, acting via the tendon, cause plantarflexes the foot at the ankle, and causes flexion at the knee.

The tendon can rupture and become inflamed.

"Achilles heel", referring to a vulnerability, relates to the mythical story of Achilles, who was slain during the Trojan war by a poisoned arrow to his heel.

Structure

Achilles tendon at foetus

The Achilles tendon is a tendon, meaning it connects muscle to bone, and is located at the back of the lower leg. The Achilles tendon connects the gastrocnemius and soleus muscle to the calcaneus, the heel bone.^[1] The tendon begins near the middle of the calf, and receives fleshy fibers on its inner surface, 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 centimetres (1.6 in) above its insertion.

The tendon is covered by the fascia and the integument, and stands out prominently behind the bone; the gap is filled up with areolar and adipose tissue. A bursa lies between the tendon and the upper part of the calcaneus. It is the thickest and strongest tendon in the body. It is about 15 centimetres (6 in) long.

Along the side of the muscle, and superficial to it, is the small saphenous vein. The tendon can receive a load stress 3.9 times body weight during walking and 7.7 times body weight when running.^[2]

Function

Acting via the Achilles tendon, the gastrocnemius and soleus muscles plantarflex the foot at the ankle. This action brings the sole of the foot closer to the back of the leg. These two muscles also flex the leg at the knee. Both muscles are innervated by the tibial nerve.^[1]

Vibration of the tendon without vision has a major impact on postural orientation.^[3] Vibration of the tendon causes movement backwards and the illusion of a forward body tilt in standing subjects.^[4] This is because vibrations stimulate muscle spindles in the calf muscles. The muscle spindles alert the brain that the body is moving forward, so the central nervous system compensates by moving the body backwards.

Clinical significance

Inflammation

Inflammation of the Achilles tendon is called Achilles tendinitis. Achilles tendinosis is the soreness or stiffness of the tendon, generally due to overuse. Inflammation was thought to be the cause of most tendon pain, until the late 1990s, when scientists discovered no evidence of inflammation.

Degeneration

Achilles tendon degeneration (tendinosis) is typically investigated with either MRI or ultrasound. In both cases, the tendon is thickened, may demonstrate surrounding inflammation by virtue of the presence of paratenonitis, retrocalcaneal or retroAchilles bursitis. 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, however may involve the insertion where this is known as enthesopathy. Though enthesopathy may be seen in the context of advancing age, it is also associated with arthritis such as gout and the seronegative spondyloarthitides. Achilles tendinosis is a known risk factor for calf muscle tears.^[5]

Rupture

Achilles tendon rupture is a partial or complete break in the tendon. Partial and full Achilles tendon ruptures are most likely to occur in sports requiring sudden eccentric stretching, such as sprinting. The area approximately two inches above the calcaneal attachment is most susceptible to these ruptures due to a zone of avascularity. Maffulli et al.^[6] suggested that the clinical label of tendinopathy be given to the combination of tendon pain, swelling and impaired performance. They require immobilization or surgery.

In a case where Achilles tendon rupture is concerned, there are three main types of treatment: the open and the percutaneous operative methods, and nonoperative approaches.

Initial treatment of damage to the tendon is generally nonoperative. Orthotics can produce early relief to the tendon by the correction of malalignments; non-steroidal anti-inflammatory drugs (NSAIDs) are generally to be avoided as they make the more-common tendinopathy (degenerative) injuries worse,^[7] though they may very occasionally be indicated for the rarer tendinitis (inflammatory) injuries. Physiotherapy by eccentric calf stretching under resistance is commonly recommended, usually in conjunction with podiatric insoles or heel cushioning.

Depending on the severity of the injury, recovery from an Achilles injury can take up to 12–16 months.

To reduce the chances of obtaining a ruptured Achilles or any other Achilles tendon complications, a few simple steps can be taken when it comes to physical activity. First, stretching the calf muscle to the point of feeling an obvious pull, as well as calf-strengthening exercises can help the muscle and tendon absorb more force resulting in less chance of injury. Second, try to avoid running or participating in physical activity on hard or slippery surfaces. Lastly, try to increase training intensity at a slow-to-medium rate. The most common Achilles tendon injuries occur when someone abruptly intensifies their training at an abnormal rate.^[8]^[9]

Other

Xanthoma can develop in the Achilles tendon in patients with familial hypercholesterolemia.

The Achilles' tendon is often tested as part of a neurological examination. In this examination, the tendon is hit with a tendon hammer. This tests the S1 and S1 spinal nerves. A healthy response is platarflexion of the foot. ^[10]

Society and culture

The name Achilles' heel comes from Greek mythology. Achilles' mother, the goddess Thetis, received a prophecy of her son's death. Hearing this, she dipped him into the River Styx to protect his body from harm. However, she kept hold of his heel, meaning that the water did not touch this part of his body and it was therefore vulnerable. During the Trojan War, Achilles was struck on his unprotected heel by a poisoned arrow shot by Paris, that killed him. In the same war, Achilles is also said to have cut behind Hector's Achilles tendons, having killed him, and threaded leather thongs through the incisions in order to drag him behind a chariot.

History

The oldest-known written record of the tendon being named for Achilles is in 1693 by the Flemish/Dutch anatomist Philip Verheyen. In his widely used text Corporis Humani Anatomia, Chapter XV, page 328, he described the tendon's location and said that it was commonly called "the cord of Achilles", now also called "tendo achillies" by anatomists. ("quae vulgo dicitur chorda Achillis")^{[citation needed]}

The Achilles tendon is also known as the calcaneal tendon. Because eponyms (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 Latin calcaneum, meaning heel.

Other animals

The Achilles tendon is short or absent in great apes, but long in arboreal gibbons and humans.^[11] It provides elastic energy storage in hopping,^[12] walking, and running.^[11] Computer models suggest this energy storage Achilles tendon increases top running speed by >80% and reduces running costs by more than three-quarters.^[11] 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."^[11]

Additional images

Dorsum and sole of Foot. Ankle joint. Deep dissection.

References

^ ^a ^b Drake, Richard L.; Vogl, Wayne; Tibbitts, Adam W.M. Mitchell; illustrations by Richard; Richardson, Paul (2005). Gray's anatomy for students. Philadelphia: Elsevier/Churchill Livingstone. p. 546. ISBN 978-0-8089-2306-0.
^ Giddings, VL; Beaupré, GS; Whalen, RT; Carter, DR (2000). "Calcaneal loading during walking and running". Medicine and science in sports and exercise 32 (3): 627–34. doi:10.1097/00005768-200003000-00012. PMID 10731005.
^ Effects of bilateral Achilles tendon vibration on postural orientation and balance during standing, 2007 International Federation of Clinical Neurophysiology. Published by Elsevier Inc.
^ ScienceDirect – Neuroscience Letters: Effect of Achilles tendon vibration on postural orientation
^ Koulouris G, Ting AY, Jhamb A, Connell D, Kavanagh ECfsr4egdggd (2007). "Magnetic resonance imaging findings of injuries to the calf muscle complex". Skeletal Radiol 36 (10): 921–7. doi:10.1007/s00256-007-0306-6. PMID 17483942.
^ Maffulli, N.; Khan, K. M.; and Puddu, G., 1998, "Overuse Tendon Conditions: Time to Change a Confusing Terminology, Arthroscopy 14(8):840-3.
^ 'Achilles injuries: How to recover', RunningInjury
^ Achilles Tendon Rupture Prevention, 1998 Mayo Foundation for Education and Research.
^ The Influence of Stretching and Warm-up Exercises on Achilles Tendon Reflex Activity, 1995 Journal of Sports Sciences. Doi = 10.1080/02640419508732265
^ Talley, Nicholas J.; O'Connor, Simon (2013). Clinical Examination: A Systematic Guide to Physical Diagnosis (7th ed.). p. 453. ISBN 9780729541985.
^ ^a ^b ^c ^d Sellers WI, Pataky TC, Caravaggi P, Crompton RH. (2010). Evolutionary Robotic Approaches in Primate Gait Analysis. Int J Primatol 31:321–338 doi:10.1007/s10764-010-9396-4
^ Lichtwark, GA; Wilson, AM (2005). "In vivo mechanical properties of the human Achilles tendon during one-legged hopping". The Journal of experimental biology 208 (Pt 24): 4715–25. doi:10.1242/jeb.01950. PMID 16326953.

External links

Image sequence demonstrating Achilles tendinosis

UpToDate Contents

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1. アキレス腱障害および腱断裂 achilles tendinopathy and tendon rupture
2. アキレス腱の関与しない後／中足関節腱障害 posterior and medial ankle tendinopathies not involving the achilles tendon
3. 若年アスリートにおける足首痛の臨床的特徴およびマネージメント clinical features and management of ankle pain in the young athlete
4. 過負荷による（慢性）腱障害のマネージメントの概要 overview of the management of overuse chronic tendinopathy
5. 若年アスリートにおける踵痛の臨床的特徴およびマネージメント clinical features and management of heel pain in the young athlete

English Journal

Outcomes of open surgery versus nonoperative management of acute achilles tendon rupture.

Amendola A.Author information Institute for Orthopaedics Sports Medicine and Rehabilitation University of Iowa Iowa City, Iowa.AbstractOBJECTIVE: To compare the outcomes (reruptures and other complications, strength, and return to work) of open surgical repair of acute Achilles tendon ruptures with nonoperative management, by means of a meta-analysis of the results of randomized controlled trials (RCTs).
Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine.Clin J Sport Med.2014 Jan;24(1):90-1. doi: 10.1097/JSM.0000000000000064.
OBJECTIVE: To compare the outcomes (reruptures and other complications, strength, and return to work) of open surgical repair of acute Achilles tendon ruptures with nonoperative management, by means of a meta-analysis of the results of randomized controlled trials (RCTs).DATA SOURCES: The online sea
PMID 24366017

Biomechanical and biochemical protective effect of low-level laser therapy for Achilles tendinitis.

Marcos RL, Arnold G, Magnenet V, Rahouadj R, Magdalou J, Lopes-Martins RÁ.Author information University of Nove de Julho, Biophotonics Applied to Health Sciences, São Paulo 01504-001, Brazil; University of São Paulo (USP), Laboratory of Pharmacology and Experimental Therapeutics, Institute of Biomedical Sciences (ICB), São Paulo 05508-900, Brazil; Université de Lorraine (UL), Ingénierie Moléculaire, Physiopathologie Articulaire (IMoPA), UMR 7365 CNRS, Biopôle, F-54505 Vandœuvre-lès-Nancy, France.AbstractFor three decades, low level laser therapy (LLLT) has been used for treatment of tendinitis as well as other musculoskeletal diseases. Nevertheless, the biological mechanisms involved remain not completely understood. In this work, the effects of LLLT and of the widely used nonsteroidal anti-inflammatory drug, diclofenac, have been compared in the case of collagenase-induced Achilles tendinitis. Wistar rats were treated with diclofenac or laser therapy. The tensile behavior of tendons was characterized through successive loading-unloading sequences. The method considered 11 characteristic parameters to describe the mechanical behavior. It was shown that during the acute inflammatory process of the tendon, the mechanical properties were significantly correlated to the high levels of MMP-3, MMP-9 and MMP-13 expression presented in a previous paper (Marcos, R.L., et al., 2012). The treatment by non-steroidal anti-inflammatory drugs such as diclofenac sodium produces a low protective effect and can affect the short-term biochemical and biomechanical properties. On the contrary, it is shown that LLLT exhibits the best results in terms of MMPs reduction and mechanical properties recovery. Thus, LLLT looks to be a promising and consistent treatment for tendinopathies.
Journal of the mechanical behavior of biomedical materials.J Mech Behav Biomed Mater.2014 Jan;29:272-85. doi: 10.1016/j.jmbbm.2013.08.028. Epub 2013 Sep 9.
For three decades, low level laser therapy (LLLT) has been used for treatment of tendinitis as well as other musculoskeletal diseases. Nevertheless, the biological mechanisms involved remain not completely understood. In this work, the effects of LLLT and of the widely used nonsteroidal anti-inflamm
PMID 24126100

Comparison of the effect of intra-tendon applications of recombinant human platelet-derived growth factor-BB, platelet-rich plasma, steroids in a rat achilles tendon collagenase model.

Solchaga LA, Bendele A, Shah V, Snel LB, Kestler HK, Dines JS, Hee CK.Author information Research and Development, BioMimetic Therapeutics, LLC, Franklin, Tennessee.AbstractThis study compared the effect of intra-tendon (IT) delivery of recombinant human platelet-derived growth factor-BB (rhPDGF-BB), platelet-rich plasma (PRP) and corticosteroids in a rat tendinopathy model. Seven days after collagenase induction of tendinopathy, a 30-µl IT injection was administered. Treatments included: saline; 3 µg rhPDGF-BB; 10 µg rhPDGF-BB; PRP; and 300 µg triamcinolone acetonide (TCA). Outcomes were assessed 7 and 21 days after treatment. All groups exhibited good to excellent repair. Relative to saline, cell proliferation increased 65% in the 10 µg rhPDGF-BB group and decreased 74% in the TCA group; inflammation decreased 65% in the TCA group. At 7 days, maximum load-to-failure was increased in the 3 µg rhPDGF-BB group relative to saline, PRP, and TCA (p < 0.025). On day 21, maximum load-to-rupture was increased in the 10 µg rhPDGF-BB group relative to saline, PRP, and TCA (p < 0.035) and in the 3 µg rhPDGF-BB group compared to saline and TCA (p < 0.027). Stiffness in the 10 µg rhPDGF-BB group was increased compared to saline, PRP, and TCA (p < 0.038). Histology demonstrated similar repair in all groups. PRP and TCA did not improve mechanical properties compared to saline. Injections of rhPDGF-BB increased maximum load-to-failure (3 and 10 µg) and stiffness (10 µg) relative to controls and commonly used treatments. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:145-150, 2014.
Journal of orthopaedic research : official publication of the Orthopaedic Research Society.J Orthop Res.2014 Jan;32(1):145-50. doi: 10.1002/jor.22483. Epub 2013 Sep 9.
This study compared the effect of intra-tendon (IT) delivery of recombinant human platelet-derived growth factor-BB (rhPDGF-BB), platelet-rich plasma (PRP) and corticosteroids in a rat tendinopathy model. Seven days after collagenase induction of tendinopathy, a 30-µl IT injection was administered.
PMID 24018586

Japanese Journal

臨床経験後脛骨筋腱機能不全・後期Stage 2に対する手術療法の成績 : 踵立方関節延長固定術と踵骨骨切り内側移動術の併用

田？正和,野口昌彦,庄野和 [他]
臨床整形外科 47(2), 147-152, 2012-02
NAID 40019203629

アキレス腱付着部裂離損傷の1例

菅野剛,関雅之
関東整形災害外科学会雑誌 42(2), 123-126, 2011-04-01
NAID 10027971221

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リンク元	「Achilles tendon」「tendo achillis」
関連記事	「tend」「calcaneal」

「Achilles tendon」

Achilles tendon
	Posterior view of the foot and leg, showing the Achilles tendon (tendo calcaneus). The gastrocnemius muscle is cut to expose the soleus.
	Lateral view of the human ankle, including the Achilles tendon
Details
Latin	tendo calcanei, tendo Achillis
Identifiers
Gray's	p.483
MeSH	A02.880.176
Dorlands; /Elsevier	t_04/12793915
TA	A04.7.02.048
FMA	FMA:51061
	Anatomical terminology