Achilles Tendon Rupture

Keywords: Achilles tendon rupture, gastrocnemius, Passive ROM, Rehabilitation, Physiotherapy, Special tests, Differential Diagnosis, execises.

This information has been displayed with the kind permission of  SportsInjuryClinic. 

Overview

Achilles tendon rupture is when the tendon that attaches the gastrocnemius and soleus to the calcaneus has a complete tear. This results in a sudden lack of strength. The person may not be able to perform heel raises or walk normally.

Clinically Relevant Anatomy

The Achilles tendon runs from the calf muscles (gastrocnemius and soleus) at the back of the lower leg and inserts in at the back of the heel. The achilles tendon can tear as a partial rupture or a total rupture. A total rupture is more common in older men who are recreational athletes.

It sometimes occurs following a history of inflammation or degeneration of the tendon. The patient will often describe a sudden event which may be walking or pushing up onto toes. When David Beckham ruptured his he immediate looked round for the other player who he had thought caused the sudden pain. Have a high suspicion if people report a sudden pain ‘like someone hit me in the back of the leg’ , particularly if they are in the right age category.

Epidermiology/Aetiology

  • Prevalence 18 per 100,000 (Leppilahti et al ,1996)
  • Men > Women
  • 30-50 years of age.

 

Characteristics and Clinical presentation

  • A sudden sharp pain as if someone has whacked you in the back of the leg with something.
  • This will often be accompanied by a load snap or bang noise.
  • You will be unable to walk properly and unable to stand on tip toe.
  • There may be a gap felt in the tendon.
  • There will be a lot of swelling.
  • A positive result for Thompson’s test.

Differential diagnosis

 

Examination

  • Click here to see ankle assessment
  • Special tests: Positive thompson test, pain, swelling.
  • Presence of palpable gap.
  • Increase/excessive passive dorsiflexion with gentle manipulation.

 

Management

General advice for patient

  • Seek professional help immediately. The sooner you see a consultant who can advise whether conservative management or surgical is more appropriate the better your prognosis will be.
  • If they need surgical intervention the recovery rates are better if seen quicker following initial injury.
  • Mr. Winson (Foot and Ankle Surgeon at Spire, Bristol) advises to not request further investigation but to refer straight to foot and ankle surgeon or attend A and E. Awaiting ultrasound on MRI would delay treatment for those with achilles rupture.
  • Apply ice or cold therapy for pain relief only.

Healthcare professional or Physiotherapy management

  • Confirm the diagnosis.
  • Operate on the tendon.
  • Sometimes the leg is put in a plaster cast or boot and allowed to heal without surgery.

Surgical

Open repair technique with the Achillon device provides good results in the treatment of acute ruptures of the Achilles tendon, restoring the ankle mobility and gait strength and stability (Garriddo et al, 2010).

How long might you be out of training for?

You can expect to be out of competition for 6 to 9 months after achilles tendon surgery. This is increased to 12 months if you just have the Achilles immobilized in plaster instead of operated on. There is also a greater risk of re-injury if you do not have the surgery.

Minimally invasive, endoscopic Achilles tendon reconstruction using semitendinosus and gracilis tendons with Endobutton stabilization (Pointek et al, 2016)

MUST READ article for Achilles Tendon Rupture (AAOS, 2009)

Sure you know this inside out? Could you explain it to a patient/ formulate a problem list and provide appropriate management? Complete the quiz to check.

References

Garrido IM, Deval JC, Bosch MN, Mediavilla DH, Garcia VP, González MS.Treatment of acute Achilles tendon ruptures with Achillon device: Clinical outcomes and kinetic gait analysis. Foot and Ankle Surgery, Volume 16, Issue 4, December 2010, Pages 189-194

Leppilahti J, Puranen J, Orava S. Incidence of Achilles tendon rupture. Acta Orthop Scand 1996;67(3):277–9.

 

Surgical Rx

Read more here…

Further Info

Read more here…

 

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