Orthopedics Book


Achilles Tendon Rupture

Aka: Achilles Tendon Rupture
  1. Definition
    1. Spontaneous heel cord rupture
  2. Epidemiology
    1. More common in men aged 30 to 50 years
    2. Sports commonly involved
      1. Basketball
      2. Football
      3. Softball
  3. 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)
  4. 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
  5. 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 dorsiflexion)
  6. Diagnosis
    1. Exercise high level of suspicion
    2. 20-30% of Achilles Tendon Ruptures are initially missed
  7. Differential Diagnosis
    1. See Heel Pain
    2. Partial Gastrocnemius Tear
    3. Achilles Tendonitis
    4. Plantaris Rupture
    5. Tibial Stress Fracture
    6. Deep Vein Thrombosis
  8. 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
  9. 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]
  10. References
    1. Greene (2001) Musculoskeletal Care p.420-1
    2. Mazzone (2002) Am Fam Physician 65(9):1805-10 [PubMed]

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