From the Guidelines
An Achilles tendon rupture occurs when the strong fibrous cord connecting the calf muscles to the heel bone completely tears, typically due to sudden force or stress on the tendon. The mechanism usually involves a sudden push-off from the foot while the knee is extended, such as during jumping, sprinting, or falling from height. Middle-aged recreational athletes are most commonly affected, particularly those who participate in sports intermittently. Risk factors include prior tendinopathy, corticosteroid use, fluoroquinolone antibiotics, and advancing age.
Clinical Findings
Clinically, patients typically report feeling or hearing a "pop" or "snap" followed by immediate pain in the back of the ankle. Some key clinical findings include:
- A palpable gap in the tendon
- Weakness in plantar flexion
- A positive Thompson test (no plantar flexion when the calf is squeezed while the patient is prone with feet hanging off the examination table) 1
- Increased passive ankle dorsiflexion with gentle manipulation
- Presence of a palpable gap (defect, loss of contour)
- Decreased ankle plantar flexion strength Patients often cannot stand on their toes on the affected side. Diagnosis is primarily clinical, though ultrasound or MRI may be used for confirmation 1. Treatment options include conservative management with immobilization and controlled early motion, or surgical repair, with the choice depending on patient factors, activity level, and the specific nature of the tear 1. Rehabilitation is crucial regardless of treatment approach, typically lasting 4-6 months before return to full activity.
From the Research
Mechanism of Achilles Rupture
- The Achilles tendon is the thickest, strongest, and largest tendon in the human body, but despite its size and tensile strength, it frequently gets injured 2.
- Achilles tendon ruptures (ATRs) mainly occur during sports activities, and their incidence has increased over the last few decades 2.
- The exact mechanism of injury is not fully understood, but it is believed to be related to a combination of factors, including overuse, trauma, and degenerative changes in the tendon.
Clinical Findings
- Achilles tendon ruptures can be classified as acute and chronic, varying on the timing of diagnosis and/or presentation to the clinic 3.
- Acute ruptures can be treated with either conservative or surgical treatment options, while chronic ruptures are best treated with augmentation of the repair, with either a gastrocnemius advancement or turndown, or a tendon transfer 3.
- Clinical findings may include a sudden onset of pain, swelling, and bruising in the affected area, as well as a palpable gap in the tendon and weakness in the ankle 2.
- Diagnosis is typically made based on a combination of clinical examination, imaging studies (such as ultrasound or MRI), and patient history.
Treatment and Rehabilitation
- Treatment options for Achilles tendon ruptures include conservative treatment and surgical repair, with the choice of treatment depending on the severity of the injury and the patient's overall health and activity level 2.
- Rehabilitation protocols for surgically repaired Achilles tendon ruptures vary, but may include early functional rehabilitation with weightbearing and mobilization, as well as eccentric exercises and stretching 4, 5, 6.
- The goal of rehabilitation is to restore strength, function, and mobility to the affected ankle, and to allow the patient to return to their normal activities and sports.