Achillies Tendon Rupture

Last updated 09.01.14

 

Definition

-  Tear/rupture of the achillies tendon

 

Rupture

 

Features

- Typically occurs within 6cm of tendon insertion onto calcaneus

-  Most commonly 2-3cm superior ton insertion

- Men 5:1 female

 

Causes

-  Sport injury: soccer, basketball, tennis

- Falling from a height

- Stepping into a hole

 

Risk Factors

- Age: mean age 35yrs

- Male

- Steroid injections

- Fluoroquinolone antibiotics

 

Associated S/S

- Sensation of snap or audible pop

- Pain, swelling

- Antalgic gait

- Increased dosriflexion on passive ROM

   

Ix

-  Ankle exam

-  Thompson Test

-  Patient supine

- Feet extending over end of bed

- Squeeze calf muscle

- Negative test: tendon intact causes foot to plantarflex

- Positive test: tendon reuptured/torn foot does not move

- Palpation of a gap in tendon

-  Small defecit better prognosis for surgical repair

-  +/- Ankle X-ray

- US of Achillies tendon

- +/- MRI

 

Mx

-  Analgesia

-  Immobilisation (cast or boot) + crutches

- Cast: Equinus Dorsal Slab (POP)

- Within 24hrs gives best chance at non-surgical management

- 8-12 layers of POP

- From MTP joints to upper third of anterior shin

- +/- Buttress slab across ankle for extra support

- Secure with crepe

-  Surgical repair 

- For complete tears

- Done ASAP (easier operation) up to 3 weeks after injury

-  Rehabilitation 

- Return to normal activity in 4-6 months

 

 

 

References

 

Mayoclinic: Achillies Tendon Rupture 

Orthopaedics About.com: Thompson Test

Wheelessonline: Achillies Tendon Rupture Rupture Exam Findings

Pic: Bionic Crossfit