Achilles tendon - wikipedia Achilles tendon Achilles tendon The Achilles tendon or calcaneal tendon is attached to the gastrocnemius and soleus muscles. Details Location Back of the lower leg Identifiers Latin tendo calcaneus, tendo Achillis MeSH D000125 TA A04. 7.02. 048 FMA 51061 Anatomical terminology ( edit on Wikidata ) The Achilles tendon or heel cord, also known as the calcaneal tendon, is a tendon of the back of the leg, and the thickest in the human body. It serves to attach the plantaris, gastrocnemius ( calf ) and soleus muscles to the calcaneus ( heel ) bone. These muscles, acting via the tendon, cause plantar flexion of the foot at the ankle, and ( except soleus ) flexion at the knee. Abnormalities of the Achilles tendon include inflammation ( Achilles tendinitis ), degeneration, rupture, and becoming embedded with cholesterol deposits ( xanthomas ). Contents 1 Structure 2 Function 3 Clinical significance 3.1 Inflammation 3.2 Degeneration 3.3 Rupture 3.4 Xanthomas 3.5 Neurological exam 4 Other animals 5 History 6 See also 7 Additional images 8 References 9 External links Structure The achilles tendon, tendo calcaneus attaches distally to the calcaneual tuberosity, and arrises superiorly from the triceps surae complex of the gastrocnemius and soleus muscles. Achilles tendon at foetus The Achilles tendon connects muscle to bone, like other tendons, and is located at the back of the lower leg. The Achilles tendon connects the gastrocnemius and soleus muscles to the calcaneal tuberosity on the calcaneus ( heel bone ). 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. The tendon is covered by the fascia and skin, 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 about 15 centimetres ( 6 in ) long. Along the side of the muscle, and superficial to it, is the small saphenous vein. The sural nerve the outer border of the tendon about 10cm below where it attaches to the bone. The tendon is the thickest tendon in the human body. It can receive a load stress 3.9 times body weight during walking and 7.7 times body weight when running. The blood supply to the Achilles tendon is poor, and mostly via a recurrent branch of the posterior tibial artery, and some through arterial branches passing through surrounding muscles. Function Acting via the Achilles tendon, the gastrocnemius and soleus muscles cause plantar flexion of the foot at the ankle. This action brings the sole of the foot closer to the back of the leg. The gastrocnemius also flexes the leg at the knee. Both muscles are innervated by the tibial nerve. 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 solus tend to attach closer to the midline. Vibration of the tendon without vision has a major impact on postural orientation. Vibration of the tendon causes movement backwards and the illusion of a forward body tilt in standing subjects. 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 Main article : Achilles tendinitis Inflammation of the Achilles tendon is called Achilles tendinitis. Achilles tendinosis is the soreness or stiffness of the tendon, particularly worse when exercising, and generally due to overuse. The most common symptoms are pain and swelling around the affected tendon. The pain is typically worse at the start of exercise and decreases thereafter. Stiffness of the ankle may also be present. Onset is generally gradual. It commonly occurs as a result of overuse such as running. Other risk factors include trauma, a lifestyle that includes little exercise, high - heel shoes, rheumatoid arthritis, and medications of the fluoroquinolone or steroid class. Diagnosis is generally based on symptoms and examination. While stretching and exercises to strengthen the calf are often recommended for prevention, evidence to support these measures is poor. Treatment typically involves rest, ice, non-steroidal antiinflammatory agents ( NSAIDs ), and physical therapy. A heel lift or orthotics may also be helpful. In those in who symptoms last more than six months despite other treatments, surgery may be considered. Achilles tendinitis is relatively common. 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 retro - achilles 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 but may involve the insertion, which is then 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. Rupture Main article : Achilles tendon rupture Achilles tendon rupture is when the Achilles tendon breaks. Symptoms include the sudden onset of sharp pain in the heel. A snapping sound may be heard as the tendon breaks and walking becomes difficult. Rupture typically occurs as a result of a sudden bending up of the foot when the calf muscle is engaged, direct trauma, or long - standing tendonitis. Other risk factors include the use of fluoroquinolones, a significant change in exercise, rheumatoid arthritis, gout, or corticosteroid use. Diagnosis is typically based on symptoms and examination and supported by medical imaging. Achilles tendon rupture occurs in about 1 per 10,000 people per year. Males are more commonly affected than females. People in their 30s to 50s are most commonly affected. Prevention may include stretching before activity. Treatment may be by surgery or casting with the toes somewhat pointed down. Relatively rapid return to weight bearing ( within 4 weeks ) appears okay. The risk of re-rupture is about 25 % with casting. If appropriate treatment does not occur within 4 weeks of the injury outcomes are not as good. Xanthomas Tendon xanthomas are cholesterol deposits that commonly develop in the Achilles tendon of people with lipid metabolism disorders such as familial hypercholesterolemia. Neurological exam 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 S2 spinal nerves : a normal response is plantar flexion ( downward movement ) of the foot. Other animals The Achilles tendon is short or absent in great apes, but long in arboreal gibbons and humans. It provides elastic energy storage in hopping, walking, and running. Computer models suggest this energy storage Achilles tendon increases top running speed by > 80 % and reduces running costs by more than three - quarters. 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. '' 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 he described the tendon 's location and said that it was commonly called `` the cord of Achilles. '' The tendon has been described as early as the time of Hippocrates, who described it as the `` tendo magnus '' ( Latin : great tendon ) and by subsequent anatomists prior to Verheyen as `` chorda Hippocratis ''. Verheyen referred to the mythological account of Achilles being held by the heel by his mother Thetis when she dipped him in the River Styx as 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. The first closed rupture was described by Ambroise Pare in the sixteenth century. The Achilles tendon is also known as the `` tendo calcaneus '' ( Latin : 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. See also Wikimedia Commons has media related to Achilles tendon. This article uses anatomical terminology ; for an overview, see Anatomical terminology. Heel lifts Additional images Dorsum and sole of Foot. Ankle joint. Deep dissection. References Jump up ^ ncbi, Functional anatomy of the Achilles tendon. Doral MN, et al. Knee Surg Sports Traumatol Arthrosc. 2010... Jump up ^ encyclopedia britannica. Jump up ^ The Science of the Skeleton and Muscles By Louise Spilsbury ‏ ، Richard Spilsbury ‏, page 32. Jump up ^ Elements of human anatomy : general, descriptive, and practical By Tobias Gibson Richardson. Jump up ^ McGlamry 's comprehensive textbook of foot and ankle surgery. Jump up ^ Robert Kennedy 's Musclemag International Encyclopedia of Bodybuilding. Jump up ^ Fascia : The Tensional Network of the Human Body - E-Book : The science and clinical applications in manual and movement therapy, by Robert Schleip ‏ ، Thomas W. Findley ‏ ، Leon Chaitow ‏ ، Peter Huijing, page 218 ‏. Jump up ^ Muscles by Carol Ballard. 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Philadelphia : Elsevier / Churchill Livingstone. p. 546. ISBN 978 - 0 - 8089 - 2306 - 0. Jump up ^ Effects of bilateral Achilles tendon vibration on postural orientation and balance during standing, 2007 International Federation of Clinical Neurophysiology. Published by Elsevier Inc. Jump up ^ Ceyte, Hadrien ; Cian, Corinne ; Zory, Raphael ; Barraud, Pierre - Alain ; Roux, Alain ; Guerraz, Michel ( April 2007 ). `` Effect of Achilles tendon vibration on postural orientation ''. Neuroscience Letters. 416 ( 1 ) : 71 -- 75. doi : 10.1016 / j. neulet. 2007.01. 044. PMID 17300868. Jump up ^ Kadakia, Anish R. `` Achilles Tendinitis - OrthoInfo - AAOS ''. OrthoInfo. Retrieved 4 July 2018. ^ Jump up to : Hubbard, MJ ; Hildebrand, BA ; Battafarano, MM ; Battafarano, DF ( June 2018 ). `` Common Soft Tissue Musculoskeletal Pain Disorders ''. Primary Care. 45 ( 2 ) : 289 -- 303. doi : 10.1016 / j. pop. 2018.02. 006. PMID 29759125. ^ Jump up to : `` Achilles Tendinitis ''. MSD Manual Professional Edition. March 2018. Retrieved 27 June 2018. ^ Jump up to : `` Achilles Tendinitis ''. OrthoInfo - AAOS. June 2010. Retrieved 26 June 2018. Jump up ^ Park, DY ; Chou, L ( December 2006 ). `` Stretching for prevention of Achilles tendon injuries : a review of the literature ''. Foot & Ankle International. 27 ( 12 ) : 1086 -- 95. CiteSeerX 10.1. 1.1012. 5059. doi : 10.1177 / 107110070602701215. PMID 17207437. Jump up ^ Peters, JA ; Zwerver, J ; Diercks, RL ; Elferink - Gemser, MT ; van den Akker - Scheek, I ( March 2016 ). `` Preventive interventions for tendinopathy : A systematic review ''. Journal of Science and Medicine in Sport. 19 ( 3 ) : 205 -- 211. doi : 10.1016 / j. jsams. 2015.03. 008. PMID 25981200. Jump up ^ `` Achilles tendinitis - Symptoms and causes ''. Mayo Clinic. Retrieved 27 June 2018. Jump up ^ Koulouris G, Ting AY, Jhamb A, Connell D, Kavanagh EC ( 2007 ). `` Magnetic resonance imaging findings of injuries to the calf muscle complex ''. 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External links Image sequence demonstrating Achilles tendinosis Muscles of the hip and human leg Iliac region Iliopsoas psoas major / psoas minor iliacus Buttocks Gluteal muscles maximus medius minimus tensor fasciae latae lateral rotator group : quadratus femoris inferior gemellus superior gemellus internal obturator external obturator piriformis Thigh / compartments Anterior sartorius quadriceps rectus femoris vastus lateralis vastus intermedius vastus medialis articularis genus Posterior hamstring biceps femoris semitendinosus semimembranosus Medial pectineus external obturator gracilis adductor longus brevis magnus minimus Fascia Femoral sheath Femoral canal Femoral ring Adductor canal Adductor hiatus Muscular lacuna fascia lata Iliotibial tract Lateral intermuscular septum of thigh Medial intermuscular septum of thigh Cribriform fascia Leg / compartments Anterior tibialis anterior extensor hallucis longus extensor digitorum longus peroneus tertius Posterior superficial triceps surae gastrocnemius soleus accessory soleus Achilles tendon plantaris deep tarsal tunnel flexor hallucis longus flexor digitorum longus tibialis posterior popliteus Lateral peroneus muscles longus brevis Fascia Pes anserinus Intermuscular septa anterior posterior transverse Foot Dorsal extensor hallucis brevis extensor digitorum brevis Plantar 1st layer abductor hallucis flexor digitorum brevis abductor digiti minimi 2nd layer quadratus plantae lumbrical muscle 3rd layer flexor hallucis brevis adductor hallucis flexor digiti minimi brevis 4th layer dorsal interossei plantar interossei Fascia Plantar fascia retinacula Peroneal Inferior extensor Superior extensor Flexor GND : 4429857 - 2 NDL : 00560137 Retrieved from `` https://en.wikipedia.org/w/index.php?title=Achilles_tendon&oldid=863658339 '' Categories : Human anatomy Tendons Lower limb anatomy Hidden categories : CS1 maint : Explicit use of et al. 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Question: the gastrocnemius muscle attaches to which tarsal bone via the achilles tendon
Answer: the calcaneus (heel) bone