From the Guidelines
To diagnose a ruptured Achilles tendon, a detailed history and physical examination, including two or more of the following tests, should be performed: Clinical Thompson test, decreased ankle plantar flexion strength, presence of a palpable gap, and increased passive ankle dorsiflexion with gentle manipulation. This approach is based on the recommendation from the study published in The Journal of the American Academy of Orthopaedic Surgeons in 2010 1. The physical examination is crucial in establishing the diagnosis, and the use of multiple tests can help increase the accuracy of the diagnosis.
Key Diagnostic Tests
- Clinical Thompson test (ie, Simonds squeeze test): This test involves squeezing the calf muscle to check for plantarflexion of the foot.
- Decreased ankle plantar flexion strength: This test assesses the strength of the ankle plantarflexion.
- Presence of a palpable gap (defect, loss of contour): This test involves palpating the Achilles tendon to check for a gap or defect.
- Increased passive ankle dorsiflexion with gentle manipulation: This test assesses the range of motion of the ankle.
Additional Diagnostic Tools
Medical imaging such as ultrasound or MRI may be ordered to confirm the diagnosis and determine the extent of the tear, particularly for partial tears which may not show a positive Thompson test 1. These tests can provide valuable information on the severity of the injury and guide treatment decisions.
Importance of Prompt Medical Attention
If an Achilles tendon rupture is suspected, it is essential to seek immediate medical attention, as prompt treatment within the first 48 hours typically leads to better outcomes. While waiting for medical care, following the RICE protocol (rest, ice, compression, and elevation) can help reduce pain and swelling.
From the Research
Diagnosis of Achilles Tendon Rupture
- The diagnosis of Achilles tendon rupture is typically made clinically, based on symptoms such as a loud popping noise and immediate pain and weakness of the lower extremity during actions like jumping or running 2.
- An MRI is often obtained for confirmation of rupture and to aid in surgical planning 2.
- The clinical presentation of Achilles tendon rupture includes pain, weakness, and a palpable gap in the tendon 3.
Clinical Presentation
- Achilles tendon rupture often occurs in middle-aged men who participate in recreational sports 2.
- The injury is characterized by a sudden onset of pain and weakness in the lower extremity, often accompanied by a loud popping noise 2.
- Patients may also experience difficulty walking or standing on their toes due to the rupture 3.
Diagnostic Imaging
- MRI is commonly used to confirm the diagnosis of Achilles tendon rupture and to evaluate the extent of the injury 2.
- Ultrasound may also be used as a diagnostic tool, although it is not as commonly used as MRI 3.
Treatment Options
- Treatment for Achilles tendon rupture can be either operative (open or minimally invasive surgery) or non-operative (functional bracing or plaster casting) 2.
- The choice of treatment depends on various factors, including the patient's age, activity level, and medical history 2.
- Surgical treatment is associated with a risk of complications, while non-operative management is associated with an increased risk of re-injury 2.