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Achilles Tendon Rupture

Achilles tendon rupture is a complete disruption of the Achilles tendon, usually occurring 2–6 cm proximal to its calcaneal insertion, where blood supply is the poorest. It can be associated with preexisting tendon degeneration and micro trauma.

The Achilles tendon is the most frequently ruptured tendon. The patient has a sudden, acute pain in the Achilles tendon with an audible snap or tear that is often described as “like being hit or kicked in the back of the leg.” 

The image shows Achilles Tendon Rupture
Achilles Tendon Rupture

Three types of indirect forces have been described:

  • Pushing off with the weight-bearing forefoot while extending the knee, such as with sprint starts and the push off in basketball.
  • Sudden, unexpected dorsiflexion of the ankle, as when the foot slips in a hole.
  • Violent dorsiflexion of a plantar flexed foot, as with a fall from a height.


Predisposing Factors
  • Disease processes: Connective tissue disorders, seronegative spondylopathies, rheumatoid arthritis, collagen vascular disease, diabetes mellitus, gout, hyperparathyroidism, renal insufficiency
  • Medications: Anabolic steroids or prolonged oral corticosteroid usage leads to degradation of collagen fibrils and decreased Achilles tendon strength. Corticosteroid injections weaken tendon structure. Fluoroquinolone antimicrobials lead to ischemia of tendon.
  • Disuse atrophy and sedentary lifestyle
  • Prolonged immobilization
  • Mechanical imbalances Body weight/obesity


Physical Examination

  • Acute complete rupture of the Achilles tendon involves a sudden, sharp pain behind the ankle, usually associated with a painful, palpable defect in the tendon.
  • Swelling and/or ecchymosis
  • Positive Thompson test is diagnostic
  • Plantar flexion strength and ability to toe rise may be decreased compared to unaffected side.
  • Passive dorsiflexion may be increased compared to unaffected side

Treatment
  • Rest, ice, compression, and elevation (RICE) are used in the early treatment of complete and partial tears.
  • Conservative treatment of an acute Achilles tendon rupture can be managed with a modern rehabilitation program.
  • Surgical options include primary open repair versus a “minimally invasive” or limited incision technique. The approach to primary open repair is usually performed just medial to the Achilles tendon, although central and lateral approaches can be used.