Ver el código de «Achilles tendon rupture»

==Background==
[[File:Achilles-tendon.jpg|thumb|Achilles tendon anatomy.]]
*Most frequently ruptures 2-6cm above calcaneus (where blood supply is weakest)
*Typical patient is 30-50yr old man who participates in strenuous activities on occasional basis
*[[Quinolone]]-associated rupture occurs in only 12 per 100,000 treatment episodes, and risk may be equivalent to oral steroids or non-quinolone antibiotics <ref>Seeger, et al, "Achilles tendon rupture and its association with fluoroquinolone antibiotics and other potential risk factors in a managed care population." PMID: 16456878 </ref>

==Clinical Features==
*Sudden, severe pain typically with rapid acceleration or pivoting
*May hear a "pop"
*Inability to run, stand on toes, or climb stairs
*Palpable defect in Achilles tendon 2-6cm proximal to calcaneus (SN 73% and SP 89% for partial tear)
*20-30% of ruptures will have some amount of active plantar flexion or be able to walk

==Differential Diagnosis==
{{Calf pain DDX}}

==Evaluation==
===Workup===
[[File:Achillessehnenruptur Sono.jpg|thumb|Achilles tendon rupture. No fracture on radiograph (left) with discontinuity of tendon over several centimeters (right; red line).]]
[[File:Achilles Tendon Rupture Butterfield.gif|thumbnail|Ultrasound of achilles tendon rupture, long axis view<ref>http://www.thepocusatlas.com/musculoskeletal/</ref>]]
*Consider x-rays to rule out fracture
*Consider [[Ultrasound: Tendons|ultrasound in equivocal cases]]
**Comparing to normal ankle can reveal smaller defects or tears

===Thompson test===
[[File:Rupture tendon achiléen.jpg|thumb|Positive Thompson test for left Achilles tendon rupture: no movement of the foot despite the calf being squeezed.]]
''(SN 96% and SP 93%)''
*Lay patient prone with knee bent at 90°
*In normal patient, squeezing calf results in plantar-flexion

===Diagnosis===
*Typically a clinical diagnosis (via positive Thompson test)

==Management==
*Rest, ice, elevation
*Non-weightbearing
*[[Short leg posterior splint]] with ankle slightly plantar-flexed
**Walking boot can be used as well <ref>Cast or Walking Boot for Achilles Tendon Rupture? https://journalfeed.org/article-a-day/2020/cast-or-weight-bearing-brace-for-non-op-achilles-tendon-rupture</ref><ref>Plaster cast versus functional brace for non-surgical treatment of Achilles tendon rupture (UKSTAR): a multicentre randomised controlled trial and economic evaluation. Lancet. 2020 Feb 8;395(10222):441-448. doi: 10.1016/S0140-6736(19)32942-3.  https://www.ncbi.nlm.nih.gov/pubmed/32035553?dopt=AbstractPlus</ref>

==Disposition==
*Outpatient with ortho referral

==References==
<references/>

[[Category:Orthopedics]]
[[Category:Sports Medicine]]