II. Definitions
- Achilles Tendon Rupture
- Spontaneous heel cord rupture
III. Epidemiology
- More common in men aged 30 to 50 years
- More common with sedentary lifestyle, when sudden or repetitive movement is introduced
- Spontaneous ruptures are related to sports in more than two thirds of cases
- Sports commonly involved
- High Jump
- Basketball
- Football
- Softball
IV. Pathophysiology
- Uncommon injury
- Results from tendon degeneration or excessive force
- Rupture site
- Os calcis (2.5 - 5 cm from tendon insertion)
V. Symptoms
- Injury from great stress on tendon (e.g. jumping)
- Patient hears "pop" at heel with injury
- Often with severe sudden acute pain
- Pain may initially be mild
VI. Signs
- Patient walks Flatfooted
- Most plantar flexion lost
- Excessive passive dorsiflexion of foot
- Unable to stand on ball of foot
- Localized tenderness achilles tendon insertion
- Localized Hemorrhage at rupture site
- Sulcus palpable at rupture site
- May be obscured by organizing clot
- Thompson's Test abnormal (no plantar flexion)
VII. Imaging
- Ruptured achilles tendon may be diagnosed clinically without imaging
- Musculoskeletal Ultrasound
VIII. Diagnosis
- Exercise high level of suspicion
- Initially missed diagnosis in 20-30% of Achilles Tendon Ruptures
IX. Differential Diagnosis
X. Management
- Orthopedic Consultation in all cases
- Surgical repair for young athletes
- Followed by immobilization for 6-8 weeks
- Immobilization
- Similar outcomes with faster recovery than surgery
- Indicated as only modality in older or less active
- Short Leg Walking Cast or cam walker
- Foot in mild equinus (plantar flexion)
- Non-weight bearing (Crutches) for at least 2-3 weeks
- Immobilize for 8-12 weeks
- Physical therapy follows immobilization
XI. Prognosis
- Recurrent Achilles Tendon Rupture is common
- Protect from excessive activity for 1 year
- Competitive athletes should expect decreased function
- Re-rupture rate
- Immobilization only: 13.4%
- Surgical repair: 1.4%
- Lo (1997) Clin J Sport Med 7:207-11 [PubMed]
XII. References
- Feldsher (2023) Crit Dec Emerg Med 37(3): 20-1
- Greene (2001) Musculoskeletal Care p.420-1
- Mazzone (2002) Am Fam Physician 65(9):1805-10 [PubMed]
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Related Studies
Concepts | Injury or Poisoning (T037) |
SnomedCT | 429513001, 268101008, 209782007, 209534004, 76647009, 156715008 |
English | Rupture of tendo achilles, Rupture of Achilles tendon (disorder), Rupture of Achilles tendon, Torn Achilles tendon, Rupture Achiles tendon, Ruptured Achilles tendon, Tendon achilles rupture of, ruptured achilles tendon, achilles tendon rupture, rupture tendo achilles, achilles ruptures tendon, of achilles tendon rupture, rupture achilles tendon, achilles ruptures tendons, rupture of achilles tendon, achiles tendon rupture, achilles ruptured tendon, rupture tendon achilles, torn achilles tendon, achilles rupture tendon, achilles tendon torn, Rupture achilles tendon, Rupture of tendo achilles (disorder), Sprain, tendocalcaneus (Achilles tendon), Achilles tendon rupture, achilles tendon; rupture, rupture; achilles tendon, rupture; tendon, achilles, tear; tendon, achilles, tendon; rupture, achilles, tendon; tear, achilles |
Dutch | geruptureerde achillespees, achillespeesruptuur, ruptuur achillespees, achillespees; ruptuur, pees; ruptuur, achilles, pees; scheur, achilles, ruptuur; achillespees, ruptuur; pees, achilles, scheur; pees, achilles |
French | Rupture du tendon d'Achille, Rupture du tendon d'Achilles |
German | Achillessehnenriss, gerissene Achillessehne, Riss Achillessehne, Achillessehne Riss |
Italian | Rottura del tendine d'Achille, Rottura di tendine di Achille, Rottura del tendine di Achille |
Portuguese | Ruptura do rendão de Aquiles, Ruptura do tendão de Aquiles, Tendão de Aquiles com ruptura |
Spanish | Tendón de Aquiles roto, ruptura de tendón de Aquiles (trastorno), ruptura de tendón de Aquiles, Rotura de tendón de Aquiles, Rotura del tendón de Aquiles, ruptura del tendón de Aquiles (trastorno), ruptura del tendón de Aquiles |
Japanese | アキレス腱断裂, アキレスケンダンレツ |
Czech | Ruptura Achillovy šlachy, Přetržená Achillova šlacha |
Hungarian | Achilles ín szakadás, Achilles-ín szakadása, Achilles-ín ruptura |