Definition

Achilles tendon rupture is usually a traumatic injury during a sporting event.

It may occur with sudden forced plantar flexion or with violent dorsiflexion in a plantar flexed foot

Rupture usually occurs 4-6 cm above the calcaneal insertion in hypovascular region

Patient usually reports a "pop" + weakness and difficulty walking + pain in heel

Risk factors

• episodic athletes, "weekend warrior"

• flouroquinolone antibiotics

• steroid injections

Physical exam

• inspection

  • increased resting ankle dorsiflexion in prone position with knees bent 

  • calf atrophy may be apparent in chronic cases

• palpation

  • palpable gap 

• motion

  • weakness to ankle plantar flexion

  • increased passive dorsiflexion

• Thompson test: lack of plantar flexion when calf is squeezed

Treatment

Conservative treatment consist of functional bracing or casting in resting equinus. It can NOT be used for late presenting cases. Tendon lengthening is common and patient should be alerted (especially if young).

Surgical repair can be an open end-to-end, or percutaneous.

For chronic cases, reconstruction with VY advancement is needed if the gap<3cm, and a flexor hallucis longus transfer is needed if gap > 3cm

Complications

rerupture, wound healing complications and sural nerve unjury ( in percutaneous approach)

This information is a brief, simple medical explanation. For exhaustive details, and before starting any kind of treatment, please refer to Dr.BAYOUD