Case Study: Achilles Tendon Rupture

Case Study : Achilles Tendon Rupture

The following case study gives you an idea of what treatments may be considered for this patient. This is a brief overview. Any CPD or case study for university would require much more depth and must be evidence based and demonstrate clear clinical reasoning. Many examples of these can be found through Pubmed and these should (alongside university guidelines)  be used as your outline for graded work.

 Introduction

A 76 year old gentleman presented with a  4/12 history of left ankle instability following a twisting injury where the patient had been running on a beach, fallen down into a hole and then was knocked over by a wave. He reports he felt a ‘tearing’ sensation and that there was immediate bruising and swelling on the medial aspect of the ankle. He reports that he was unable to weight bear for 2-3 weeks but did not see his doctor at this stage. He reported that there had been some pins and needles initially however this had now resolved.  Symptoms are aggravated with walking and eased with rest. The patient reports minimal pain but feelings of discomfort, instability and reduced function due to a limp.

The patient was seen by the GP who prescribed NSAIDs and had also referred for an ankle X-ray. The X-Ray confirmed no fracture therefore he was referred to physiotherapy at this point. The gentleman is retired however a keen fisherman and goes shooting regularly.

Clinical Impression

On examination the patient stands with reduced weight through the left lower limb. He was unable to perform a bilateral or unilateral heel raise. There was significant swelling of the posterior aspect of the ankle. The patient had full active ROM of the left ankle and good dorsiflexion, inversion and eversion. Plantar flexion was achieved however weak 3/5. There was thickening of the left tendo achilles and tenderness along the distal 3rd. There was a palpable dip 4cm from its insertion onto the calcaneous. Significant wasting of both the soleus and gastroc was present with trigger points situated on the medial aspect of these muscles. Thompson test on the left was positive.

These findings fitted with an achilles tendon rupture.

Treatment Goals

  • Establish clear diagnosis to guide future management
  • Reduce swelling
  • Stabilise and protect tendoachilles in case of partial rupture.
  • Avoid activities that may cause rupture if partial rupture present ie heel raise, excessive dorsiflexion.

Management

  • Advised RICE guidelines to manage swelling. ( Relative rest, Ice 20mins 3-4 daily, compression of tape, elevation)
  • Taped in plantar flexion 10 degrees, TA offload with supportive figure of 8 to reduce swelling.
  • Refer to GP for further investigations to rule out TA rupture/partial rupture.
 

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photo credit: San Diego Shooter via photopin cc

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