Subcutaneous rupture of the Achilles tendon: basic science and some aspects of clinical practice.

Achilles, the legendary warrior and hero of Homer's Iliad, lends his name to the Achilles tendon, the thickest and strongest tendon in the human body.' Achilles' mother Thetis attempted to make her son invulnerable by immersing him in the waters of the river Styx after being told by a prophet that her son was destined to die in battle. However, the heel by which his mother held him remained untouched by the water, and thus Achilles had a vulnerable point. Achilles did go to battle, as the leader of the forces of Myrmidons whose task was to destroy Troy.' He killed Hector, leader of the Trojans, and Troy was subsequently captured. However, Hector's death was avenged by his brother Paris, who killed Achilles by firing a poisoned arrow into his heel. Hippocrates is credited with the first description of injury to the Achilles tendon. He stated that "this tendon, if bruised or cut, causes the most acute fevers, induces choking, deranges the mind and at length brings death".3 Ambroise Pare, the French military surgeon regarded as the father of modern surgery, is credited with the first description of rupture of the Achilles tendon in 1575. Pare believed that the affected leg should be strapped with bandages dipped in wine and spices, but he was not hopeful of a good result.4 The first description of surgical repair of a ruptured Achilles tendon was by Polaillon in 1888.4 Tendon suture was not a new idea, as it had been advocated as early as the 10th century AD by an Arabian physician. In the 12th century AD, William of Falicet, an Italian surgeon, stated that nature was unable to unite divided tendons, and that surgeons could make a much better job of it. Many researchers have attempted to elucidate the aetiology ofAchilles tendon rupture, but its true nature still remains unclear. There is also still disagreement regarding the best method of treatment for an acute Achilles tendon rupture. Some workers advocate surgical repair, whereas others insist that surgery is unnecessary, and is an unacceptable risk.