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Achilles Tendon Rupture
Aka: Achilles Tendon Rupture
- Definition
- Spontaneous heel cord rupture
- Epidemiology
- More common in men aged 30 to 50 years
- Sports commonly involved
- Basketball
- Football
- Softball
- Pathophysiology
- Uncommon injury
- Results from tendon degeneration or excessive force
- Rupture site
- Os calcis (2.5 - 5 cm from tendon insertion)
- 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
- 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)
- Diagnosis
- Exercise high level of suspicion
- 20-30% of Achilles Tendon Ruptures are initially missed
- Differential Diagnosis
- See Heel Pain
- Partial Gastrocnemius Tear
- Achilles Tendonitis
- Plantaris Rupture
- Tibial Stress Fracture
- Deep Vein Thrombosis
- 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
- Weber (2003) Am J Sports 31:685-91 [PubMed]
- 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
- 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]
- References
- Greene (2001) Musculoskeletal Care p.420-1
- Mazzone (2002) Am Fam Physician 65(9):1805-10 [PubMed]