Contents
Mechanism
- Loading activity, stop-and-go sports (e.g. squash, tennis, basketball)
- Secondary to chronic tendonitis, steroid injection
Clinical Features
- Audible pop, sudden pain with push off movement
- Sensation of being kicked in heel when trying to plantarflex
- palpable gap
- apprehensive toe off when walking
- weak plantar flexion
- Thompson test: with patient prone, squeezing the calf muscles should passively plantar flex the foot to demonstrate intact Achilles tendon
- postive test = no passive plantar flexion = ruptured tendon
Treatment
- Low demand or elderly: cast foot in plantar flexion (to relax tendon) x 8-12 weeks
- High demand: surgical repair, then cast as above x 6-8 weeks
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PEARL
The most common site of Achilles tendon rupture in 2-6 cm from its insertion where there is an area of relative hypovascularity. |