II. Definition

  1. Spontaneous heel cord rupture

III. Epidemiology

  1. More common in men aged 30 to 50 years
  2. Sports commonly involved
    1. Basketball
    2. Football
    3. Softball

IV. Pathophysiology

  1. Uncommon injury
  2. Results from tendon degeneration or excessive force
  3. Rupture site
    1. Os calcis (2.5 - 5 cm from tendon insertion)

V. Symptoms

  1. Injury from great stress on tendon (e.g. jumping)
  2. Patient hears "pop" at heel with injury
  3. Often with severe sudden acute pain
    1. Pain may initially be mild

VI. Signs

  1. Patient walks Flatfooted
    1. Most plantar flexion lost
    2. Excessive passive dorsiflexion of foot
    3. Unable to stand on ball of foot
  2. Localized tenderness achilles tendon insertion
  3. Localized Hemorrhage at rupture site
  4. Sulcus palpable at rupture site
    1. May be obscured by organizing clot
  5. Thompson's Test abnormal (no plantar flexion)

VII. Diagnosis

  1. Exercise high level of suspicion
  2. 20-30% of Achilles Tendon Ruptures are initially missed

VIII. Differential Diagnosis

IX. Management

  1. Orthopedic Consultation in all cases
  2. Surgical repair for young athletes
    1. Followed by immobilization for 6-8 weeks
  3. Immobilization
    1. Similar outcomes with faster recovery than surgery
      1. Weber (2003) Am J Sports 31:685-91 [PubMed]
    2. Indicated as only modality in older or less active
    3. Short Leg Walking Cast or cam walker
      1. Foot in mild equinus (plantar flexion)
    4. Non-weight bearing (Crutches) for at least 2-3 weeks
    5. Immobilize for 8-12 weeks
    6. Physical therapy follows immobilization

X. Prognosis

  1. Recurrent Achilles Tendon Rupture is common
  2. Protect from excessive activity for 1 year
  3. Competitive athletes should expect decreased function
  4. Re-rupture rate
    1. Immobilization only: 13.4%
    2. Surgical repair: 1.4%
    3. Lo (1997) Clin J Sport Med 7:207-11 [PubMed]

XI. References

  1. Greene (2001) Musculoskeletal Care p.420-1
  2. Mazzone (2002) Am Fam Physician 65(9):1805-10 [PubMed]

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Related Studies

Ontology: Rupture of Achilles tendon (C0263970)

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